e4 Travel and Events - Passport Form

Please read thoroughly and confirm you understand each item by checking the box next to it.

I acknowledge that: *

All information provided must EXACTLY match the traveler(s) passport(s).

I may experience delays and/or incur fees imposed by travel vendors due to incorrect information provided in this form.

All travelers need a Passport Book for re-entry to the United States by international air.
A Passport Card is only valid for re-entry to the U.S. at land border crossings of entry from Canada and Mexico

All passports MUST be valid at least 6 months beyond the intended return date from any foreign country. Even if passport(s) are unexpired, I/we risk being denied boarding at the airport or being detained upon arrival in the country.

The State Department may deny a traveler's application for a new or renewed passport for certain reasons.

Entry into foreign countries may be denied under certain circumstances, including by not limited to: unpaid child support, a prior felony conviction, or HIV status.

By signing and dating this form, I agree to the terms above.

Legal Name *

First Middle Last Suffix

Address *

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

Phone # *

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

Today's Date *

MM / DD / YYYY

Signature *

Clear

Traveler #1

Full Legal Name *

First Middle Last Suffix

As listed on passport

U.S. Passport Number *

Passport Issue Date *

MM / DD / YYYY

Passport Expiration Date *

MM / DD / YYYY

Date of Birth *

MM / DD / YYYY

Place of Birth *

State and Country

Mobile Phone #

For during travel emergency use only

Email *

Traveler #2

Name

First Middle Last Suffix

U.S. Passport Number

U.S. Passport Issue Date

MM / DD / YYYY

U.S. Passport Expiration Date

MM / DD / YYYY

Date of Birth

MM / DD / YYYY

Place of Birth

State and Country

Mobile Phone #

For during travel emergency use only

Email

Traveler #3

Name

First Middle Last Suffix

U.S. Passport Number

U.S. Passport Issue Date

MM / DD / YYYY

U.S. Passport Expiration Date

MM / DD / YYYY

Date of Birth

MM / DD / YYYY

Place of Birth

State and Country

Mobile Phone #

For during travel emergency use only

Email

Traveler #4

Name

First Middle Last Suffix

U.S. Passport Number

U.S. Passport Issue Date

MM / DD / YYYY

U.S. Passport Expiration Date

MM / DD / YYYY

Date of Birth

MM / DD / YYYY

Place of Birth

State and Counry

Mobile Phone #

For during travel emergency use only

Email

Traveler #5

Name

First Middle Last Suffix

U.S. Passport Number

U.S. Passport Issue Date

MM / DD / YYYY

U.S. Passport Expiration Date

MM / DD / YYYY

Date of Birth

MM / DD / YYYY

Place of Birth

State and Country

Mobile Phone #

For during travel emergency use only

Email

Almost done!

When you click SUBMIT, you will be directed to the State Department's Smart Traveler Enrollment Program (STEP) website. We strongly recommend enrolling in this program so the U.S. Embassy in each country you visit can contact you and your family in the event of an emergency.

Thanks for providing your passport information! Please contact us if you have any questions.

-Regina