Sure Flaneur Travel Traveler Information & Emergency Contact Form

Your Name (name you prefer to be called): _________________________________

What pronoun do you prefer? (he/him she/her they/them other?) (please circle one)

VACCINATED? (optional): You have received a full vaccination for Covid-19 and also the latest recommended booster shot(s) for your age group? YES / NO (circle one)

Your Mailing Address: __________________________________________________________

city__________________state____________zip__________________

Date of BIRTH: day_______/mo_________/yr__________

FULL NAME as it appears on your passport: _____________________________________________

Passport Number: ____________________________

Passport Expiration: day_______/mo_________/yr__________

Country of Your Passport: _____________________

Your Email Address: ________________________@______________

Your Phone Numbers: (_____)______-____________ or (_____)______-____________

Emergency Contact Person (not on trip): __________________________________

Emergency Contact Email: ________________________@______________

Emergency Contact Phone: (_____)______-____________

Emergency Contact Phone (alternate): (_____)______-____________

Please acknowledge the following:

1) Everything you are submitting in this form and via alternate communications to Sure Flaneur Travel, it's agents and assigns is true and representative of you, the Traveler? YES / NO (circle one)

2) You are aware of the CANCELLATION/REFUND policy? YES / NO (circle one)

3) You agree to SIGN & SUBMIT the TRIP LIABILITY FORM and return a hard copy? YES / NO (circle one)

How did you hear about our trips? (optional)

When completed, please return via email or snail-mail to Sure Flaneur Travel, POBox 777, Port Townsend, WA 98368