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    PLEASE PRINT OR TYPE

    MrMrsMs.Dr.

    NEWMODIFICATION

    Traveler Name (as on driver’s license/passport):

    Gender:MaleFemale

    DOB:

    Title:

    Department:

    Frequent Flyer Membership/Numbers (attach a separate sheet if necessary)

    • Airline:

    • Number:

    • Name on Card:

    • Status:

    • Business Phone/Extension :

    • Home Phone (required for afterhours assistance) :

    • Fax Number:

    • Cell Phone :

    • Pager Number/PIN code :

    • Travel Arranger Name & Phone

    Car Rental Club Membership/Numbers (attach a separate sheet if necessary)

    • Rental Agency:

    • Number:

    • Name on Card :

    • Status:

    • Car Size/Special Request :

    Hotel Club Membership (attach a separate sheet if necessary

    • Hotel Name :

    • Number:

    • Name on Card:

    • Status :

    • Room Type Preference

    • Credit Card:

    • Number:

    • Name on Card :

    • Expiration :

    • Billing Address:

    • City/State/Zip:

    • Passport Number:

    • Expiration:

    • Citizenship:

    • Home Address:

    • City/State/Zip:

    • E-Mail Address :

    • Other E-Mail Addresses (travel arranger/assistant) :

    • Airline Seating Preferences AisleWindowOther

    • Special Meals (i.e., low fat, vegetarian, etc.)

    • Please make note of any special travel needs:

    AN IMPORTANT REMINDER REGARDING YOUR “TRAVEL NAME"

    Your name, as entered on your profile, will be the name all airline tickets are issued under, unless otherwise specified at the time of booking. It is becoming more important that this name be consistent in your travel life. Here are three important reasons:

    • If you travel internationally, the name on your ticket MUST MATCH the name on your passport

    • Ticketless travel is becoming more popular every day and your picture I.D. presented at check-in must match the name on your ticket.

    • If you belong to any frequent flyer clubs, most of them now require the name on your ticket to match the name under which your frequent flyer account is set up. In some cases, if these names do not match, you will not be credited frequent flyer miles

    AFTER HOURS ASSISTANCE

    We are requesting a home phone number in order to advise you of flight cancellations. However, if you choose not to give a home number, it will not be noted in your profile

    CONFIDENTIALITY

    We do not sell this information to anyone. The information given on this profile form is for the sole use of R|A Travel to enhance the quality of service we provide.

    THANK YOU FOR GIVING US THE OPPORTUNITY TO SERVE YOU! I HEREBY AUTHORIZE RA TRAVEL TO UTILIZE THE ABOVE CREDIT CARD INFORMATION AS REQUESTED BY ME OR A PERSON I DESIGNATE, AND TO SIGN SUCH CHARGES “SIGNATURE ON FILE”.

    • SIGNATURE OF TRAVELER

    • DATE

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