Triton College Undergraduate Center Preliminary On-Line Trip Application Form

Please fill in as much "contact" information for us as you can at this time. If you do that, it will save us time later. Certainly do not fill in anything that makes you uncomfortable.

But at the very least, please fill out your name and address so that we can send you the actual "Enrollment Form" from the corporate tour provider via U.S. Mail, and the other tour materials. Then you can look them over and decide.

PRIVACY POLICY: Information you give us here will ONLY be used by the Triton College Study & Travel Program for the tour you are indicating that you are interested in , and for the purpose of informing you about upcoming Study & Travel tours. It will not be given to any third parties or used for any other purpose. The company with whom we contract to provide the tour will have published their own "Privacy Policy" that is not related to the Triton College Study & Travel Program, although they will request some of the same information. You should read it carefully also.

If you should ever want to have your information removed from this database, please send me an email with your request. ---Dr. Salzman salzmana@triton.edu

* Required

First Name *

Middle Name

Last Name *

Address 1 *

Address 2

City *

State *

Zip *

Date of Birth

Alternate Email

Your Home Phone with Area Code

Your Cell Phone with Area Code

Preferred contact method *

IN WHAT COUNTRY do you or will you hold a valid PassPort? If you are a foreign national or hold a non-U.S. passport, there may be special visa requirements. Check with your nation's embassy or legation.

PassPort Name (exactly as it appears or will appear on your PassPort) Remember: when you fill out the Enrollment Form from the Tour Provider, be sure that the name on the ENROLLMENT FORM is exactly the same as the name on the PASSPORT.

Allergies, dietary restrictions, and pertinent health information This is a privacy issue, and giving out this information right here is up to you. For example, you may not care if everyone knows that cat hair makes you sneeze. On the other hand, you may NOT want everyone to know about your athlete's foot. Before we leave, however, BE SURE that the Tour Leader knows of any critical health and medication issues.

Emergency Contact Person's Name For example, if the plane is delayed on its return flight, or you have a health issue, who should we call ?

Emergency Contact Work (or Daytime) phone and Cell no.

Emergency Contact Evening (e.g., home & cell numbers)

ALTERNATE EMERGENCY CONTACT Please give all of the information we will need to contact this person.

Is Your EMERGENCY CONTACT Information the Same as your RIDE HOME information? We may need to know who will be picking you up at the Airport when we return.

SAME
DIFFERENT
DOES NOT APPLY (e.g., you are making othe arrangements, e.g., you are taking a taxi home from the airport.)

If you checked "Different", who is picking you up? Give name, all of his/her phone numbers, and any other information you think it is pertinent to share.

Comments? Questions? Did we forget to ask you about something important?