Travel Registration Form

Travel Registration Form
Legal Name as it Appears on ID or Passport (Passenger #1)*

First NameMiddle NameLast NameSuffix
Gender (Passenger #1)*
Date of Birth (Passenger #1)*
MM/DD/YYYY
Address (Passenger #1)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone (Passenger #1)

Area CodePhone Number
Cell Phone (Passenger #1)*

Area CodePhone Number
E-mail (Passenger #1)*
Known Traveler #
IE: Pre-check, Global Entry, etc
Medical Condition/Special Needs that may affect travel arrangements, including dietary?
For ANY travel outside of the United States
Passport Number Passenger #1
Country of Issue
Country of Citzenship*
Expiration Date
Date of Issue
Legal Name as it Appears on ID or Passport (Passenger #2)

First NameMiddle NameLast NameSuffix
Address (Passenger #2)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Gender (Passenger #2)
Date of Birth (Passenger #2)
MM/DD/YYYY
E-mail (Passenger #2)
Home Phone (Passenger #2)

Area CodePhone Number
Cell Phone (Passenger #2)

Area CodePhone Number
Known Traveler #
IE: Pre-check, Global Entry, etc
Medical Condition or Special Needs that may affect travel arrangements, including dietary?
For ANY travel outside of the United States
Passport Number Passenger #2
Country of Issue
Country of Citizenship
Expiration Date
Date of Issue
Legal name as it appears on ID or passport (Passenger #3)

First NameMiddle NameLast NameSuffix
Gender (Passenger #3)
Date of Birth (Passenger #3)

MonthDayYear
Date
Address (Passenger #3)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone (Passenger #3)

Area CodePhone Number
Cell Phone (Passenger #3)

Area CodePhone Number
E-mail (Passenger #3)
example@example.com
Known Traveler #
IE: Pre-check, Global Entry, etc
Medical Condition or Special Needs that may affect travel arrangements, including dietary?
For ANY travel outside of the United States
Passport Number Passenger #3
Country of Issue
Country of Citizenship
Expiration Date
Date of Issue
Legal name as it appears on ID or passport (Passenger #4)

First NameMiddle NameLast NameSuffix
Gender (Passenger #4)
Date of Birth (Passenger #4)

MonthDayYear
Date
Address (Passenger #4)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone (Passenger #4)

Area CodePhone Number
Cell Phone (Passenger #4)

Area CodePhone Number
E-mail (Passenger #4)
example@example.com
Known Traveler #
IE: Pre-check, Global Entry, etc
Medical Condition or Special Needs that may affect travel arrangements, including dietary?
For ANY travel outside of the United States
Passport Number Passenger #4
Country of Issue
Country of Citizenship
Expiration Date
Date of Issue
Some countries deny entry to travelers with a past conviction in a court of law. If this may impact you, please contact an attorney to determine if you may travel internationally.
Are you and everyone in your traveling party legally able to travel outside of the US?*

YesI need to check with my attorney first.
Emergency Contact*
Contact Phone*

Area CodePhone Number
Relationship*
Please list any additional information about your booking
(Example: room types requested, special needs/medical conditions, etc.)
PLEASE REVIEW ALL INFORMATION BEFORE SUBMITTING!

By clicking submit, I verify that I have reviewed all the listed information for accuracy. I understand that any misspellings or errors may cause a booking amendment fee, loss of promotional items and/or cause cancellation of my booking. If cancelled, I could incur fees by the travel supplier (see suppliers cancellation policy).

While not required, we highly recommend travel protection insurance. You will be provided a quote and information about the travel insurance coverage. As we are not licensed agents for the insurance companies, any specific coverage questions will have to be made to the insurance company.
I have been informed about travel protection insurance and wish to....*
Please check that you have verified information and acknowledge it is true and correct.*

Information is correct.
Journey Scapes Travel 503-558-4418 lara@journeyscapestravel.com
Should be Empty:

Travel Registration Form

For ANY travel outside of the United States

For ANY travel outside of the United States

For ANY travel outside of the United States

For ANY travel outside of the United States