Department of Health Education & Behavior
Travel Profile Form
Fields marked (Required) must be completed to create your profile.
IMPORTANT NOTE
YOUR NAME AND AIRPORT SECURITY: Please make certain that the first,
middle, and last names shown are identical to those on the photo identification
that you will be presenting at the airport.
First Name (Required)
Home Address
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Emergency Contact Information
Name
Street
City
Postal/Zip Code
Phone Number
Nickname
Middle Name
No Middle Name
Last Name (Required)
Street
City
State/Province/Region
Postal/Zip Code
Country
Contact Informatio
Work Phone (Required)
Home Phone
Relationship
Address same as employee
State/Province/Region
Country
Cell Phone
Email Address (Required)
Travel Preferences
Eligible for the following discount travel rates/fare classes (select from drop down)
Seating Section
Special Meals
Don't Care
Non-Smoking
Smoking
Smoking Preference
Air Travel Preferences
Seat
Preferred Departure Airport
Other Air Travel Preferences
Medical Alerts
Hotel Preferences
Car Transmission
In-car GPS system
Message to Car Rental Vendor
Frequent-Traveler Programs
Your Frequent Traveler, Driver, and Hotel Guest Program
(Please enter programs exactly as they appear on your card, excluding spaces and dashes. Do not add any
additional characters. Do not include the carrier code. If you enter a program incorrectly, we will get a profile
error from the reservation system. For example, if your card is printed "AA12345" or "John Doe/12345", then
your program number is 12345.)
Air/Rail Carrier: Include carrier & frequent traveler #
Hotel: Include hotel chain & guest #
AAA/CAA
Government
Military Senior/AARP
Please select your preference for seat, seating section, and special meal needs from drop down menu.
Foam Pillows
Room Type
Please select your preferred room type from drop down menu.
Message to Hotel Vender
I prefer a hotel that has:
Accessibility Needs
Car Rental Preferences
Smoking Preference
a gym a pool
a restaurant room service
Early check-in
Wheelchair access
Blind accessible
Please select your preference for smoking and car transmission from the drop down menus.
The Transportation Security Authority (TSA) requires us to transmit some information. Providing gender and
date of birth is required. If it is not provided, you may be subject to additional screening or denied transport or
authorization. For more on TSA privacy policies or to view the records notice and the privacy assessment, see
the TSA's web site at WWW.TSA.GOV.
Gender (Required)
Date of Birth (mm/dd/yyyy) (Required)
Male
Female
The DHS redress number is a unique number that helps TSA eliminate watch list
misidentification. If you have a name similar to or the same as a name on the current
terrorist watch list, and have experienced secondary security screenings at the airports, you
will have the option of preventing this in the future by providing your Redress Number at
the time of booking. To apply for a Redress Number go to the TSA web site.
DHS Redress No.
TSA Pre Check (Known Traveler Number)
On Oct. 4, 2011 the Transportation Security Administration (TSA) launched an expedited
screening pilot program called TSA Pre-Check. CBP has partnered with TSA on this
Department of Homeland Security initiative, which is designed to help TSA focus resources
on higher- risk and unknown passengers while expediting the process for lower- risk and
known passengers whenever possible. The Known Traveler Number is a unique number
assigned to "known travelers" from whom the Federal Government has already conducted a
treat assessment and has determined do not pose a security threat. For more information
about this program, or to locate your known traveler number, click here: http://
www.globalentry.gov/tsa.html.
International Travel: Passports and Visas
Adding your passport information to your profile will allow us to include it in your reservations. Having this
information in your reservation can make international travel a little easier.
Passports
I do not have a passport.
Passport Nationality
Passport Number
Passport Date Issued (mm/dd/yyyy)
Passport Expiration (mm/dd/yyyy)
Passport Place Issued (City, State)
Passport Place Issued (Country)
International Visas
Visa Nationality
Visa Type
Visa Number
Visa Expiration (mm/dd/yyyy)