Membership Application Form

Client Information and Travel Policy

Name must match spelling on id documentation: license or passport. Alpha Journeys will not be held responsible for receiving incorrect information. Prices are not guaranteed until deposit or full payment is completed.-- No airline ticket may be transferred to another person at any time.- Cruises: A deposit of $250/person is due at the time of booking in order to secure a cabin on the ship.- It is the responsibility of each traveler to know what documentation is required for entry into another country by going to http://travel.state.gov- It is recommended that travel insurance is purchased for all trips. Alpha Journeys will not be held responsible for failure to comply.
Name*

PrefixFirst NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Home Number

Area CodePhone Number
Cellular Number*

Area CodePhone Number
Date of Birth*

MonthDayYear
Citizenship*
Emergency Contact (not traveling with you)*

First NameMiddle NameLast Name
Emergency Contact Phone*

Area CodePhone Number
Emergency Contact Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Passport Information
Birth Country
Passport Number
Issue Date

MonthDayYear
Expiration Date

MonthDayYear
Issuance Country
Special Celebrations
Handicap Needs
I have read the Client Information and Travel Policy*

Yes
Should be Empty:

Client Information and Travel Policy