EmailMe Form - Global Citizen Journeys Client Booking Form

Client 1 Name *

as it appears on your passport

Client 1 Birthdate *

MM / DD / YYYY

Client 1 Passport # *

Client 1 Nationality *

Client 1 Place of Birth *

State/Country

Client 1 Passport Issuing Authority *

Client 1 Passport Issue Date *

MM / DD / YYYY

Client 1 Passport Expiration date *

MM / DD / YYYY

Client 1 Personal Information

(Please list any dietary restrictions, mobility issues or medical concerns)

Client 1 Passport Copy

Some destinations, accommodations or tickets require copies of passports. Should this be applicable, you will be notified during the booking process. Otherwise we encourage you to provide this to verify the information stated above. (File options are: pdf, png, jpg, jpeg or tif.)

Client 2 Name

as it appears on your passport

Client 2 Birthdate

MM / DD / YYYY

Client 2 Passport #

Client 2 Nationality

Client 2 Place of Birth

State/Country

Client 2 Passport Issuing Authority

Client 2 Passport Issue Date

MM / DD / YYYY

Client 2 Passport Expiration date

MM / DD / YYYY

Client 2 Personal Information

(Please list any dietary restrictions, mobility issues or medical concerns)

Client 2 Passport Copy

Some destinations, accommodations or tickets require copies of passports. Should this be applicable, you will be notified during the booking process. Otherwise we encourage you to provide this to verify the information stated above. (File options are: pdf, png, jpg, jpeg or tif.)

Primary Address for Communication *

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

Primary Email for Communication *

Primary Phone Number *

### - ### - ####

Please upload a picture of you and those who you'll be traveling with

Emergency Contact Person *

First Last

Emergency Contact Relationship *

Emergency Contact Phone Number *

### - ### - ####

Emergency Contact Email *

You may make deposit or final payment by check/money order, Venmo (+1.9% fee), wire transfer (+$18 fee) or by credit card (+3% fee).

Please choose your preferred method(s) of payment for the trip deposit *

Check/Money order

Venmo

Wire transfer

Credit card

Please choose your preferred method(s) of payment for the final payment *

Check/Money order

Venmo

Wire transfer

Credit card