Program Registration Form

Salutation: (Mr./Mrs./Ms.)*

Full Name: (First/Middle/Last)*

(Legal name as appears on your passport. Note: The name on your airline ticket must be the same as the name on your passport.)

Accompanying Guest Name: (Mr./Mrs./Ms.)

*Please complete separate registration form for accompanying guest(s)

Room Preference: (Single or Double)*

Company Name:*

Email:*

Home Address:*

City/Town:*

Province:*

Postal Code:*

Home Phone:*

Business Phone:

Cell Phone:

Date of Birth: (dd/mmm/yyyy)*

Passport #:*

Expiry Date: (dd/mmm/yyyy)*

Citizenship/Country of Issue:*

Air Canada Aeroplan #:

Name as appears on account:

Food Allergies or Health Issues we should know about:

Physical Limitations:

Please list name & telephone number of person to contact in case of an emergency:*

CAPTCHA Code:*

Any questions email Fran@viptravelgroup.com or call Fran in Kitchener at 519-747-2316 or Toll Free 1-800-561-1282

Privacy Statement

VIP Travel has created this statement in order to demonstrate our firm commitment to privacy. VIP Travel will not disclose or sell any of your personal information, including your name, address, phone number or email address, to any third party. We use this information strictly for internal purposes, to help serve you more efficiently.