Travel Request Form

MGB Profile and Travel Request Form
Traveler must provide a MGB affiliated email address
Business Unit and Cost Center
Billing Information
MGB Affiliations/Hospital*
Department Name*
Billing Business Unit *
4 digit number
Cost Center/Fund Number*
6 characters
TRAVELER INFORMATION

The following information is required for TSA compliance, Great Getaways internal records, reservation ticketing, and MGB Risk Management.
Traveler Legal Name*

Last Name First Middle
Traveler Legal Name (as it appears on your passport if different from above )

Last Name First Middle
Traveler Mobile Phone Number*

Area Code Phone Number
Traveler Mobile Phone Number *
Area code and number
Business Email*
example@example.com
Would you like a travel profile setup for future travel?*

YesNo
Would you like to receive our vacation specials?

YesNo
Please provide a personal email address :
example@example.com
If you would like to receive our travel magazine please provide your home address:

Street Address
Street Address Line 2
City State / Province
Postal / Zip Code

Travel Profile
Birth Date*

Month Day Year
Gender (as it appears on your Passport or Government Issued ID)*
Gender must match Government ID
TSA Pre✔ Known Traveler Number (KTN) GOES
Redress Control Number (redress number)
Travel Arranger Name (if different from traveler)

First Name Last Name
Travel Arranger Email
example@example.com
Arranger Phone Number
Area code and number
Arranger Phone Number

Area Code Phone Number

Frequent Flyer Accounts and Memberships
Membership AAA (For hotel savings, may need to present card at check in-if you have an AAA fare)

Yes
FREQUENT FLYER NUMBERS
American Airlines
*If you have a frequent flyer account, please list here.
Delta Airlines
*If you have a frequent flyer account, please list here.
JetBlue
*If you have a frequent flyer account, please list here.
United Airlines
*If you have a frequent flyer account, please list here.
Southwest Airlines
*If you have a frequent flyer account, please list here.
British Airways
*If you have a frequent flyer account, please list here.
Frequent Flyer other
*If you have a frequent flyer account, please list here.
Frequent Flyer other
*If you have a frequent flyer account, please list here.
HOTEL MEMBERSHIP NUMBERS
Marriott Bonvoy
Hilton
Hyatt
Priority Club
Hotel
Hotel
CAR RENTAL MEMBERSHIP NUMBERS
Hertz Membership
Enterprise Membership
Other Car Rental Membership

Companion Traveler
Companion Traveler Name (as it appears on your Passport or Government Issued ID)

Last Name First Name/Middle
Birth Date

Month Day Year
Companion Gender (as it appears on your Passport or Government Issued ID)
Companion Traveler Phone Number

Area Code Phone Number
Companion Email
example@example.com
Companion GOES/TSA Pre-Check/Known Traveler Number
Frequent Flyer Numbers
*Please indicate Preferred Airlines followed by your FF number, in order of preference
Companion Special Needs/requests
*Please list any special needs requests or air or car preferences

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During the process of providing travel services, Great Getaways may collect, store, and transmit your personally identifiable information such as name, address, contact information, preferences, demographic information, as well as any hotel or travel requests you provide us. This information is necessary for the facilitation of your travel reservation. This information may be shared with other 3rd parties, such as event organizers, planners, affiliated organizations, and travel and lodging providers. Should you wish to manage the information entrusted to Great Getaways, you can by contacting us via mgbtravel@ggatravel.com

Travelers and arrangers are responsible for complying with the travel policy of their MGB Institution, Department, and Grant(s) as well as government rules and regulation
Click the Box*
Preferred Return Time
*Please choose your preferred departure time.
Corrupt Departure Date & Preferred Departure Time

MonthDay Year
Hour Minutes AM/PM Option
Corrupt Return Date & Preferred Return Time

MonthDay Year
Hour Minutes AM/PM Option
Should be Empty:

MGB Profile and Travel Request Form