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Please enter your name below as it appears on your passport. Your airline ticket will be issued per your registered name. Fees may apply if changes are made to a name and/or date of birth after issuing your airline ticket.
Traveler #1: First name as it appears on passport
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Traveler #1: Middle name as it appears on passport
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Traveler #1: Last name as it appears on passport
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Traveler #1: Known Traveler Number - Global Entry, TSA Pre-check (note: you must reconfirm your KTN with the airline upon check-in):
Traveler #1: Name preference for your name tag:
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Traveler #1: Frequent Flyer Number(s) (note: you must reconfirm your FF# with the airline upon check-in):
Traveler #1: Date of birth (MM/DD/YYYY):
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Traveler #1: Email Address:
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Traveler #1: Email Confirmation:
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Traveler #1: Street Address
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Traveler #1: Address Line 2
Traveler #1: City:
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Traveler #1: State:
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Traveler #1: Zip Code:
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Traveler #1: Home Phone Number:
Traveler #1: Cell Phone Number:
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Traveler #1: Are you a solo traveler or traveling with a travel companion?
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Traveling Solo
With a Companion
Looking for a Roommate "Pair & Share"
Traveler #2: First name as it appears on passport:
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Traveler #2: Middle name as it appears on passport:
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Traveler #2: Last name as it appears on passport:
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Traveler #2: Known Traveler Number (Global Entry, TSA Pre-check):
Traveler #2: Name preference for your name tag:
*
Traveler #2: Frequent Flyer Number(s) (note: you must reconfirm your FF# with the airline upon check-in):
Traveler #2: Date of birth (MM/DD/YYYY):
*
+
Traveler #2: Email Address:
Traveler #2: Email Confirmation:
Traveler #2: Street Address:
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Traveler #2: Address Line 2:
Traveler #2: City:
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Traveler #2: State:
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Traveler #2: Zip Code:
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Traveler #2: Home Phone Number:
Traveler #2: Cell Phone Number:
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Are you interested in a quote for Travel Insurance?
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Yes
No, I decline travel insurance
Do you have any allergies, incl. dietary restrictions? (If yes, please specify below or simply write "None"):
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0/300 characters
Do you have any medical conditions you would like to share with your local tour guide (will be kept completely confidential) that would be useful to know to assist you better in case of a medical emergency? (If yes, please specify below, or simply write "None"):
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0/300 characters
Bed preference for double rooms: One bed or two separate beds (will be requested, but cannot be guaranteed):
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0/300 characters
Please provide at least one emergency contact person (name, cell phone number, email address):
If you are traveling with friends, please list their names here:
Traveler #1: Color copy of passport (attach now or send to Executive Travel minimum 90 days prior to departure)
Traveler #2: Color copy of passport (attach now or send to Executive Travel minimum 90 days prior to departure)
I have read and agree with the General Terms and Conditions found on Executive Travel's website under Escorted Tour. I also understand that it is my responsibility to check these up to the time of departure as they may change.
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Yes
How would you like to make your deposit payment? (please note: if you choose to pay by credit card and you register two people, both deposits will be charged to this card)
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Check
Credit Card
Name on Card
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Credit Card Type
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Visa
MasterCard
American Express
Discover
Credit Card Number
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CVC Code
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Expiration Date (mm/yy)
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PIN Number (if applicable)
By submitting this form, you authorize Executive Travel to charge this credit card for the deposit amount for the traveler(s) above.
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