UNLV Medical, Guatemala, January 2022 (Social Media)-Flight Reservation Form

First name*

Exactly how it appears on your passport

Middle name

Exactly how it appears on your passport

Last name*

Exactly how it appears on your passport

Date of birth*

Sex*

Male
Female

Passport issue country*

From which country is your passport (e.g., USA)? *Note: if you do not have an updated passport, please contact us ASAP.

Passport number*

Passport expiration date*

Phone number*

E.g., (555) 555-5555

Email address*

E.g., yourname@gmail.com

USA airport from which you wish to depart*

MSP
IAH
I wish to depart from an airport different than the group (see below)

Please put all that apply (e.g., MSP, IAH); group will be departing from MSP or IAH

Departure airport preference different than group (only complete if applicable)

If you wish to depart from an airport different from the group, please indicate so below with your preferred airport(s) and note/comment

USA airport at which you wish to arrive*

MSP
IAH
I wish to arrive at an airport different than the group (see below)

Please put all that apply (e.g., MSP, IAH); group will be arriving to MSP or IAH

Arrival airport preference different than group (only complete if applicable)

If you wish to arrive at an airport different from the group, please indicate so below with your preferred airport(s) and note/comment

VAW Outreach trip dates*

I wish to travel with my team on our trip dates (Jan 6-13)

The trip dates for your team are Jan 6-13.

Special meal request*

Certain airlines offer special meals for those with dietary restrictions. We will do our best to communicate your dietary needs with the airline. However, we cannot guarantee it and you should double check directly with the airline at least 48 hours prior to departure.

Frequent flyer number (if applicable)

Please include the airline(s) name(s) and frequent flyer(s) number(s) you have, if applicable.

Additional comments & notes

Any information you would like us to know when booking your flight (eg, you will not be traveling with the group)

VAW Flight Terms and Conditions*

I have read and agree to the VAW Flight Terms and Conditions.

VAW Flight Terms and Conditions: I understand that the information I fill out here will be sent directly to the travel agent. I understand that if there is a mistake on this form, I will be responsible for covering the charges for any changes required once my ticket has been issued. I acknowledge and agree to these terms and conditions.

Attestation*

I assert that the information I have provided in this application is true and accurate.

UNLV Medical, Guatemala, January 2022 (Social Media)--Flight Reservation Form

Flight Reservation Form

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