The University of Texas Health Science Center at San Antonio

      TRAVELER PROFILE
      Fax to: 366-0474


       


      Corporate Travel Planners, Inc.

      NAME _________________________________________  EMP BADGE ID# _________________________

      o DR o MRS o MR o MS o OTHER (Specify) __________________________
      TITLE _______________________________________ DEPT _____________________________________
      PHONE __________________________________ FAX __________________________________________
      E-MAIL ___________________________________

      TRAVEL ARRANGER NAME ______________________________ PHONE __________________________
      TRAVEL ARRANGER NAME ______________________________ PHONE __________________________
      TICKET DELIVERY LOCATION (BLDG/ROOM) __________________________________________________
      HOME ADDRESS __________________________________________________________________________
      HOME PHONE _______________________________ HOME FAX __________________________________

      AIRLINE INFORMATION

      AVG TRIPS PER YEAR: _______ Business _______ Personal
      SEAT SELECTION: o Bulkhead o Window o Forward o Rear o Smoking o Non-smoking
      AIRLINE PREFERENCE: ____________________ Domestic _____________________ International
      SPECIAL MEAL PREFERENCE _______________________________________________________________
      FREQUENT FLYER MEMBERSHIPS
      Airline Number Award Level Name on Card
      __________________________ ____________ _____________ _____________________________

      __________________________ ____________ _____________ _____________________________
       

      OTHER AIRLINE INFORMATION _______________________________________________________________

      ___________________________________________________________________________________________

      ___________________________________________________________________________________________

      CREDIT CARD INFORMATION

      Card ___________________________ Card No. ______________________________ Exp. __________

      Card ___________________________ Card No. ______________________________ Exp. __________

      Card ___________________________ Card No. ______________________________ Exp. __________
       
       
       
       
       


      CAR INFORMATION
      COMPANY PREFERENCE: o Avis o Advantage o _________________________
      AVIS NO. _________________________________ ADVANTAGE NO. __________________________________
      OTHER CO. NO. ___________________________ OTHER CO. NO._ __________________________________
      SIZE PREFERENCE: o Manual Subcompact o Automatic Subcompact o Compact o Midsize
      o Full size o Non-smoking o Other ____________________________________________________
      Make and Model Preference ______________________________________________________
      HOTEL INFORMATION
      CHAIN PREFERENCES ______________________________________________________________________
      Hotel Chain Member No. Hotel Chain Member No.
      ________________________ _______________ ________________________ _______________
      ________________________ _______________ ________________________ _______________
      o Smoking o Non-smoking

      PASSPORT INFORMATION
      Passport No. ____________________________________________________ Exp. Date ______________
      Date of Issue ___________________ Place of Issue ________________________________________
      Place of Birth _____________________________________ Date of Birth ______________________
      Citizenship(s) ____________________________________________________________________________

      ADDITIONAL INFORMATION (Family member names and relationships; special travel requirements; etc.)

      ___________________________________________________________________________________________

      ___________________________________________________________________________________________

      ___________________________________________________________________________________________

      I hereby authorize the travel agency checked above to process charge card vouchers and charge my travel arrangements to the above credit cards for all travel requested by me or by my travel arranger. I agree to pay all such charges as incurred. I understand that ALL information given above is kept confidential.
       
       

      SIGNATURE __________________________________________________ DATE ______________________

      Fax completed form to Corporate Travel Planners, 366-0474. Questions? Call 562-6216.

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      F395-040-098