Traveler Information Form

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Please complete one form per traveler in order to expedite your travel reservation. Required fields are marked with a red asterisk. Double-check ALL entries before submission.
Please indicate your membership type. Choose only one.*

I am a state/U.S. territory/District of Columbia/tribal representative with sponsored travel.I am a NASAAEP Board of Director.I am an Exhibitor and Sponsor.
Full name as it appears on your Government Issued ID - do NOT use middle initials!*

First & Middle Last Name
Name as you'd like it for your Summit name tag.

First NameLast Name
Gender*

FemaleMale
Birth Date*

MonthDayYear
E-mail to Receive your Travel Confirmations.*
Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone number to reach you in case of questions*

Area CodePhone Number
Preferred home airport... (You may spell it out or use the three digit airport code. REQUIRED if we are booking your flights.)
Date of desired Departure to Summit (NOTE: Any deviations from the standard of Monday, December 2, 2024 will need to be approved by the NASAAEP Board.)*

MonthDayYear
Date of desired Return to Home (NOTE: Any deviations from the standard Friday, December 6, 2024 will need to be approved by the NASAAEP Board.)*

MonthDayYear
Rooming with... (Please fill in the names of anyone that you will be sharing a room with for this trip.)
Have any loyalty numbers you want included on your reservation? Type them here with brand and number. Use one line per loyalty program, please. (Please note: Sometimes you will not earn points due to the booking route used, but we will do our best to include loyalty numbers when we can.)
Any other details you'd like us to know such as: Preferred air departure/arrival times? Alternate airports you'd consider? Dietary needs? Medical equipment you'll be bringing with you? Assistance needed at the airport? If you don't let us know now, we cannot change things later.
By placing my electronic signature here, I affirm that the information supplied above is true and correct. I understand that any errors in spelling or birth date on reservations may require additional charges to correct that I, as the traveler, will be personally responsible for. An early departure from the Summit WILL incur penalties from the hotel, airline, and/or travel agency; I agree to notify Dream Vacations immediately if my travel plans change so we can minimize the penalties incurred. By booking with Dream Vacations, you consent to the occasional email or snail mail from us; you can unsubscribe or change emails at any time. To accept these terms and submit your traveler form, simply hold down your left mouse button and move your mouse to spell out your signature. If you need to start over, click clear and try again.*

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READ BEFORE COMPLETING!