|
Ker &
Downey
General
Client Profile
RETURN THIS PAGE WITH ALL OTHER PRE TOUR DOCUMENTS
ONE FORM
PER PARTICIPANT
PERSONAL
DATA:
Name as it
appears on passport:
_________________________________________________________________________
Home
Address:
______________________________________________________________________________________
City:
_________________________________________ State:
_______________________ Zip: ____________________
Occupation: __________________________________________ Sex: F ______ M
_______
Date of
Birth: _______________________ Place of
Birth:_____________________________________________________
Daytime
Contact Number: _______________________________ Evening Contact
Number: __________________________
Fax:
___________________________________________ Email:
______________________________________________
Passport
Number: ________________________________________Date Issued:
______________ Expires: _____________
Place of
issue: _______________________________________ Nationality of
Passport: ____________________________
Emergency
Contact Name:
_____________________________________________________________________________
Emergency
Contact Number:
___________________________________________________________________________
ACCOMMODATIONS:
As the
relationship of the members of your party will affect accommodations,
please state who (if anyone) will share your accommodations.
___________________________________________________________________________________________________
FOOD:
Do you
have any particular dietary requirements that we should be made aware?
(Attach list if necessary)
___________________________________________________________________________________________________
___________________________________________________________________________________________________
MEDICAL:
If you
have any medical problems that we should be made aware of, please list
below.
___________________________________________________________________________________________________
___________________________________________________________________________________________________
INSURANCE:
It is very
important that we have some basic information on medical insurance
coverage. Please provide this information now so it is available if
required.
Insurer:
___________________________________________ Plan Number:
______________________________________
Insurer's
address:
_____________________________________________________________________________________
Coverage
Type (if applicable):______________________________ Policy Number:
__________________________________
You are
not covered by liability insurance. Although we take every possible
care, we cannot be held responsible for any accident, injury or illness
that you may incur, or loss or damage to your property during your tour.
We ask
that you leave all valuables at home.
You have
been advised of the Tour Protection Plan (trip cancellation and
interruption insurance) offered by Ker & Downey. If not, please contact
us and ask for details. We highly recommend our clients purchase such
insurance.
MISC:
How did
your hear about us?
____________________________________________________________________________________________________
____________________________________________________________________________________________________
What
travel periodicals do you read most often?
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Please
list any other information you feel will be of benefit to us in
executing your tour. Will your or anyone in your party be celebrating a
birthday or special event?
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Return
this page with all other pre tour documents to 281 371 2514
Agent
Code BRO001
Booking Ref KHFI105099
Consultant Kim Cooper
Booking Name Brown and Keene Eg
Ker &
Downey, 6703 Highway Blvd., Katy, TX 77494
Direct:
281-371-2500 - Toll Free: 800-423-4236 - Fax: 281-371-2514 - info@kerdowney.com
- www.kerdowney.com |
