Select the Number of Travelers - (NOTE: This is who you are paying for. Separate couples or family members paying directly, need to submit their own profile)
*
1
2
3
4
5
6
Traveler 1
Traveler 1
Full Name as Listed on id
*
First Name
Middle Name
Last Name
Home Number
-
Area Code
Phone Number
Mobile Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Traveler 1 Occupation
*
Upload Your Clear Passport Photo Here
*
Browse Files
Cancel
of
Traveler 1 Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Female
Male
Is Traveler 1 part of the Global Entry (GOES) program? If so, provide your Known Travel number.
*
Please provide the name(s) of the hotel or airline loyalty program(s) and the loyalty program NUMBER(s) that you want credit for when booking services. Or say none.
*
Example Delta 206553987
Hotel Room Preferences (Room Temperature, Bedding Type, Pillow Type, Additional Towels, Music Preference, etc)
*
I customize VIP Welcome Amenities based on your likes, dislikes, personal interests. (Please provide as much information as possible (including allergies), so your experience is tailormade for you. The more I know, the better I can wow everyone.)
*
Any notes for preferences, dislikes, allergies, mobility issues, and ANY special requests I should be aware of to make your trip the best experience.
*
Mini Bar Preferences - when within my control and customizable, I will ensure your minibar is filled with what you like.
*
If I am able to customize it, this will assist me to load you with your favorites.
Please share any additional details, likes, dislikes that would be important to your travel experience that we should be aware of.
*
The more you tell us for do's and dents the better we can plan the best experience
Complimentary Welcome Gift Preferences (select ALL that apply)
*
Healthy Foods
Sweet Treats
Savory Treats
Still Water
Sparking Water
Red Wine
White Wine
Sparking Wine
Rose Wine
Beer
Other
What is Traveler 1's favorite Color?
*
What is Traveler 1's favorite morning beverage?
*
What is Traveler 1's favorite evening beverage or cocktail?
*
Would you like me to set you up for Booking Virtuoso Hotels online? There is NO FEE for my help or connections to use this service. I help manage all the perks, benefits and VIP status. You simply book the hotels online, thru a special link I share with you.
*
Yes
No Thank you
Would you like to receive marketing pieces via email, mail, or both?
*
Yes, Email only
Yes, Post mail only
Yes, both email and post mail
No, thanks
What has been your favorite vacation and what specifically made it so great?
*
What are your top three hotel stays and why? (Service, View, Decor, Location, Staff, Perks, etc)
*
The more you tell us the better we can recommend places
Traveler 1 Emergency Contact Information
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Relation
*
Email
*
Is this the best emergency contact for all travelers?
*
Yes
No
Back
Next
Traveler 2
Traveler 2
Full Name as Listed on Passport or Government id
*
First Name
Middle Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Mobile Number
*
-
Area Code
Phone Number
Traveler 2 Occupation
*
Upload Your Clear Passport Photo Here
*
Browse Files
Cancel
of
Traveler 2 Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Female
Male
Is Traveler 2 part of the Global Entry (GOES) program? If so, provide your Known Travel number.
*
Check if Traveler 2 has Loyalty Program records (e.g. Hotel, Rental Car, or Frequent Flier numbers) and would like Travel With Melissa to keep them on file
Please provide the name(s) of the loyalty program(s) and the loyalty program number(s)
*
What is Traveler 2's favorite Color?
*
What is Traveler 2's favorite morning beverage?
*
What is Traveler 2's favorite evening beverage or cocktail?
*
Traveler 2 Emergency Contact Information
Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Relation
Email
Back
Next
Traveler 3
Traveler 3
Full Name as Listed on Passport or Government id
*
First Name
Middle Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Mobile Number
*
-
Area Code
Phone Number
Upload Your Clear Passport Photo Here
*
Browse Files
Cancel
of
Traveler 3 Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Female
Male
Is Traveler 3 part of the Global Entry (GOES) program? If so, provide your Known Travel number.
*
Check if Traveler 3 has Loyalty Program records (e.g. Hotel, Rental Car, or Frequent Flier numbers) and would like Travel With Melissa to keep them on file
Please provide the name(s) of the loyalty program(s) and the loyalty program number(s)
What is Traveler 3's favorite Color?
*
Traveler 3 Emergency Contact Information
Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Relation
Back
Next
Traveler 4
Traveler 4
Full Name as Listed on Passport or Government id
*
First Name
Middle Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Mobile Number
*
-
Area Code
Phone Number
Upload Your Clear Passport Photo Here
*
Browse Files
Cancel
of
Traveler 4 Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Female
Male
Is Traveler 4 part of the Global Entry (GOES) program? If so, provide your Known Travel number.
*
Check if Traveler 4 has Loyalty Program records (e.g. Hotel, Rental Car, or Frequent Flier numbers) and would like Travel With Melissa to keep them on file
Please provide the name(s) of the loyalty program(s) and the loyalty program number(s)
What is Traveler 4's favorite Color?
*
Traveler 4 Emergency Contact Information
Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Relation
Back
Next
Traveler 5
Traveler 5
Full Name as Listed on Passport or Government id
*
First Name
Middle Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Mobile Number
*
-
Area Code
Phone Number
Upload Your Clear Passport Photo Here
*
Browse Files
Cancel
of
Traveler 5 Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Female
Male
Is Traveler 5 part of the Global Entry (GOES) program? If so, provide your Known Travel number.
*
Check if Traveler 5 has Loyalty Program records (e.g. Hotel, Rental Car, or Frequent Flier numbers) and would like Travel With Melissa to keep them on file
Please provide the name(s) of the loyalty program(s) and the loyalty program number(s)
What is Traveler 5's favorite Color?
*
Traveler 5 Emergency Contact Information
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Relation
*
Back
Next
Traveler 6
Traveler 6
Full Name as Listed on Passport or Government id
*
First Name
Middle Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Mobile Number
*
-
Area Code
Phone Number
Upload Your Clear Passport Photo Here
*
Browse Files
Cancel
of
Traveler 6 Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Female
Male
Is Traveler 6 part of the Global Entry (GOES) program? If so, provide your Known Travel number.
*
Check if Traveler 6 has Loyalty Program records (e.g. Hotel, Rental Car, or Frequent Flier numbers) and would like Travel With Melissa to keep them on file
Please provide the name(s) of the loyalty program(s) and the loyalty program number(s)
What is Traveler 6's favorite Color?
*
Traveler 6 Emergency Contact Information
Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Relation
Back
Next
*
I acknowledge, for myself and any travel companions, that airlines and other service providers require the name and date of birth on each passengers passport to match the name on record used to make the reservation. I understand that all names and dates of birth submitted via this form will be used to book flights and other requested services. I understand that any incorrect submissions may result in change or cancellation fees to reissue services with the correct information. Travel With Melissa is not liable for any incorrectly submitted information on this form.
*
I acknowledge that all passengers listed on this form if requesting an international travel either have or will obtain a passport that is valid for at least 6 months after travel return date and that airlines will not allow boarding if any passports are not in compliance with this requirement. Travel With Melissa is not liable for damages or additional costs that may result from using an invalid passport document.
Please verify that you are human
*
Submit
Should be Empty: