EmailMe Form - EMBARK Travel Client Profile Form

FULL NAME (as it appears on Government issued ID): *

First Middle Last

Please make sure you list the name exactly as it appears on your Government issued ID (Passport, Driver's License)

Gender: *

Male

Female

Mailing Address: *

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

Phone: *

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

Phone Type:

Home

Cell

Business

Email Address:

Date of Birth: *

MM / DD / YYYY

Legal Document Information:

Are you a US Citizen? *

Yes

No

Do you have a Passport? *

Yes

No

If Yes, Please Enter Passport Number:

If you don't have this information yet, please get it to me as soon as you can.

Passport Issue Date:

MM / DD / YYYY

Passport Expiration Date:

MM / DD / YYYY

Issuing State:

TSA Pre-Check KTN:

What Date Are you Looking to Travel? *

MM / DD / YYYY

IF ALL-INCLUSIVE, PLEASE INDICATE ROOM PREFERENCE:

PLEASE FILL OUT ONLY IF BOOKING AN ALL-INCLUSIVE LAND VACATION

IF CRUISING, PLEASE INDICATE CABIN PREFERENCE:

PLEASE FILL OUT ONLY IF CRUISING

IF CRUISING AND ARE PART OF A GROUP CRUISE, PLEASE LIST GROUP NAME:

COMPLETE THIS FIELD ONLY IF YOU ARE PART OF A GROUP CRUISE

TRAVEL PARTNER INFORMATION

Please use this section to list who will be traveling with you.

Travel Partner Name (as it appears on Government issued ID):

First Middle Last

Please make sure name is exactly as it appears on Government issued ID (Passport, Driver's License)

Gender:

Male

Female

Travel Partner Date of Birth:

MM / DD / YYYY

Phone

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

Travel Partner Email Address:

Travel Partner a US Citizen?

Yes

No

Does your Travel Partner have a Passport?

Yes

No

If Yes, Please Enter Passport Number:

Passport Issue Date:

MM / DD / YYYY

Passport Expiration Date:

MM / DD / YYYY

Issuing State:

TSA Pre-Check KTN:

Anniversary Date:

MM / DD / YYYY

If married, please let us know your anniversary date.

ADDITIONAL PASSENGER INFORMATION

If you are traveling with friends or children, please list them here.

Additional Traveler's Name (as it appears on Government issued ID):

First Middle Last

Please make sure name is exactly as it appears on Government issued ID (Passport, Driver's License, Birth Certificate)

Phone

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

Email

Gender:

Male

Female

Additional Traveler's Date of Birth:

MM / DD / YYYY

Are they a US Citizen?

Yes

No

Do they have a Passport?

Yes

No

If Yes, Please Enter Passport Number:

Passport Issue Date:

MM / DD / YYYY

Passport Expiration Date:

MM / DD / YYYY

Issuing State:

TSA Pre-Check KTN:

Additional Traveler's Name (as it appears on Government issued ID):

First Middle Last

Please make sure name is exactly as it appears on Government issued ID (Passport, Driver's License, Birth Certificate)

Phone

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

Email

Gender:

Male

Female

Additional Traveler's Date of Birth:

MM / DD / YYYY

Are they a US Citizen?

Yes

No

Do they have a Passport?

Yes

No

If Yes, Please Enter Passport Number:

Passport Issue Date:

MM / DD / YYYY

Passport Expiration Date:

MM / DD / YYYY

Issuing State:

TSA Pre-Check KTN:

Additional Traveler's Name (as it appears on Government issued ID):

First Middle Last

Please make sure name is exactly as it appears on Government issued ID (Passport, Driver's License, Birth Certificate)

Phone

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

Email

Gender:

Male

Female

Additional Traveler's Date of Birth:

MM / DD / YYYY

Are they a US Citizen?

Yes

No

Do they have a Passport?

Yes

No

If Yes, Please Enter Passport Number:

Passport Issue Date:

MM / DD / YYYY

Passport Expiration Date:

MM / DD / YYYY

Issuing State:

TSA Pre-Check KTN:

Additional Traveler's Name (as it appears on Government issued ID):

First Middle Last

Please make sure name is exactly as it appears on Government issued ID (Passport, Driver's License, Birth Certificate)

Phone

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

Email

Gender:

Male

Female

Additional Traveler's Date of Birth:

MM / DD / YYYY

Are they a US Citizen?

Yes

No

Do they have a Passport?

Yes

No

If Yes, Please Enter Passport Number:

Passport Issue Date:

MM / DD / YYYY

Passport Expiration Date:

MM / DD / YYYY

Issuing State:

TSA Pre-Check KTN:

Do you or any of your travel mates have any allergies I should know about?

If Yes, please list allergies in the field below.

Please list Guest and allergies below:

Do you or your travel mates have any special dietary needs?

If other, please list below.

Please enter any information here that you feel may help me with planning your trip.

We do not need to know if you have a criminal history, BUT it is important that you understand any travel restrictions based on your criminal history. International travel, including cruises, will require an immigrations check that may not allow you to travel if you were convicted of a felony, have back child support, a DUI or other legal issues. If you are on parole, you must have permission from your parole officer to travel. If you have finished your sentence, even if it was many years ago, we urge you to visit Travel.State.Gov and check for any restrictions to your destination. Some destinations have more strict rules than others. By submitting this form, you accept responsibility and absolve EMBARK Travel of any responsibility if you are denied travel due to criminal history OR lack of proper documentation. Not checking this box will invalidate this form and no travel arrangements will be made. *

I understand and agree

I understand that it is my responsibility to have proper travel documentation for the destinations I am traveling to. If I have questions about my travel documentation, I will refer to www.travel.state.gov and will ask questions of my travel agent well in advance of travel. EMBARK Travel nor the agent, nor the tour operator in which I book my trip through are responsible for ensuring that I have proper travel documentation. *

I understand and agree