Client Profile
Please complete the form in its entirety.
Full Name
*
First Name
Last Name
Date of Birth
*
/
Month
/
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
E-mail
example@example.com
Rooming Option Booked
*
I booked single occupancy.
I booked double occupancy, and will need roommate matching.
I booked double occupancy, and my roommate is: (please provide roommate name below.)
Roommate Name (if applicable)
First & Last Name
Roomate Date of Birth
-
Month
-
Day
Year
MM/DD/YYYY
Emergency Contact:
First Name
*
Last Name
*
Phone Number
*
Relation
*
*
I acknowledge that payments made to Berry Amazing Travel LLC dba Amazing Travel Chicks are non-refundable and non-transferable, and I have been advised to purchase travel insurance to protect my investment.
Signature
Clear
Submit
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