Personal Data Form for Trip Print and take a copy of this form with you on your trip. Also leave a copy at home with a friend or relative.

Personal Information

Full name
Nickname
Home address
Home phone
Mobile or cellular phone
Home fax
Home e-mail address
Birthday (MM/DD/YYYY)
SSN
Passport number
Driver’s license number

Business Information

Company
Business address
Job title
Business phone
Business fax
Business e-mail address
Manager’s name and phone
Assistant’s name and phone
Web page address

Emergency and Medical Information

In case of emergency, contact
Emergency contact’s address
Emergency contact’s phone
Doctor’s name
Doctor’s phone
Doctor’s address
Medical insurance carrier and member number
Blood type
Known medical conditions
Known allergies
Current medications

Airline Information

Flight #1	Flight #2	Flight #3	Flight #4
Date
Airline
Airline phone number
Flight number
Departure city
Departure time
Destination city
Arrival time

Car Rental Information

Pick-up date
Company
Company phone number
Confirmation number
Quoted rental rate
Pick-up location
Drop-off location
Drop-off date

Hotel Itinerary

Date	Hotel	City, Country	Reservation confirmation number	Phone number

Credit Cards and Travelers Checks

Credit card type	Issuing bank	Credit card no.	Phone number

Traveler’s check type	Value	Check number	Phone number