If changing an existing profile, you need only complete: 
            Traveller Name, Company Name, and the fields that require updating.

Title:

First Name:

Last Name:

Company Name:

Department:

E-mail:

Travel Arranger:

Home Phone:

Office Phone:

Extension:

Fax:

Home Address:

City:

Province:

Postal Code:

Emergency Contact:

Phone:

Airline Preferences:

Seating Preference:

Type of Aircraft Preferred:

Special Meals Required:

Airline Frequent Flyer

PLEASE NOTE

Enrollment name must match traveler's name exactly in order to receive mileage credit from airline.

Airline:

Membership Number:

Name: (as it appears on membership)

Physical Challenges or Personal Preferences

(Please provide any relevant information that may assist us in meeting your special travel requirements.)

Preferred Hotels

Hotel Name:

City or Region:

Room Type:

Membership ID #:

Smoking or Non Smoking?

Special Requirements?

Blacklisted Hotels?

Preferred Car Rental Program

Rental Company:

City or Region:

Car Type:

Membership ID #:

Citizenship Information

Passport Number:

Expiry Date:

Nationality:

Credit Card Numbers for Billing

Card Company:

Card Number:

       Expiry Date:

Airline Tickets:   

Hotel Guarantee:   

Personal Travel:   

** Note: If you prefer, please call VIP Travel during regular business hours
at 519-747-1282 or 1-800-561-1282, to provide us with this information.

  I authorize VIP Travel to use the above credit card(s) for travel services and/or hotel guarantee.