EmailMe Form - BAPS Client Information and Disclaimer Agreement

Lead Person
Name *
Prefix First Middle Last Suffix
PLEASE READ CAREFULLY
Please type your name EXACTLY how it appears on your passport. Make sure your names match your passport or government issued ID exactly how it appears including your middle name if applicable. If your name does not match exactly as it appears on your ID, you may be denied boarding or be subject to an additional airline name change fee.
Number of Passengers
Select the number of passengers in your group. *

Passengers
PASSENGER 1

Name
Prefix First Middle Last Suffix
Contact Number *
### - ### - ####
Email *
Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Date of Birth
MM / DD / YYYY
Place of Birth
Country of Citizenship
Passport Number
Passport Issued By
Passport Issue Date
Passport Expiration Date
Known Traveler Number
Frequent Flyer Program
American Airlines
Delta Airlines
Southwest Airlines
United Airlines
Other
Frequent Flyer Program Number
PASSENGER 2

Name
Prefix First Middle Last Suffix
Contact Number
### - ### - ####
Email
Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Date of Birth
MM / DD / YYYY
Place of Birth
Country of Citizenship
Passport Number
Passport Issued By
Passport Issue Date
Passport Expiration Date
Known Traveler Number
Frequent Flyer Program
American Airlines
Delta Airlines
Southwest Airlines
United Airlines
Other
Frequent Flyer Program Number
PASSENGER 3

Name
Prefix First Middle Last Suffix
Contact Number
### - ### - ####
Email
Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Date of Birth
MM / DD / YYYY
Place of Birth
Country of Citizenship
Passport Number
Passport Issued By
Passport Issue Date
Passport Expiration Date
Known Traveler Number
Frequent Flyer Program
American Airlines
Delta Airlines
Southwest Airlines
United Airlines
Other
Frequent Flyer Program Number
PASSENGER 4

Name
Prefix First Middle Last Suffix
Contact Number
### - ### - ####
Email
Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Date of Birth
MM / DD / YYYY
Place of Birth
Country of Citizenship
Passport Number
Passport Issued By
Passport Issue Date
Passport Expiration Date
Known Traveler Number
Frequent Flyer Program
American Airlines
Delta Airlines
Southwest Airlines
United Airlines
Other
Frequent Flyer Program Number
I verified that our birth dates above are correct and match our passports or government issued IDs for all passengers. *
Yes
No
I verified that our names listed above are exactly as they appear on our passports or government issued IDs. *
Yes
No
Passports are required to be valid for 6 months after the date your travel is completed. Please check all travelers' passports and then complete this section. *
Our passports do not expire for at least 6 months after the date of travel.
One or more of our passports are expiring and we will renew them prior to travel. We will check with Travel.StateGov for the amount of time it will take to receive the passports..
This is for domestic travel and a passport book is not required.
Please Note: While a Passport Card is a less expensive option than a Passport Book, the Passport Card is NOT accepted for international travel. The Passport Card can be accepted for identification while taking a cruise that starts and ends in the United States, but if an emergency should occur while you are out of the country and need to be transported back to the United States, the Passport Card will not be accepted.
Entry and Exit Restrictions

There may be some entry and exit restrictions based on each country for visitors. These restrictions are set forth by the foreign governments and include DUI's, health concerns, vaccinations, child safety and support, offensive actions, or any felony arrest history. It is the traveler's full responsibility to check and verify entry, exit, passport, and visa requirement to avoid entry and exit issues. For more information, please go to www.travel.state.gov.

If you book this trip you will not receive a refund and Bags Already Packed Specialty Travel will not be held responsible for you not being able to enter into another country. *
Yes, I understand
Yes, I understand and would like to discuss this further
Agency Disclosure and Responsibility
Zandra Black with BAPS Travel issues these travel documents in the sole capacity as an agent for the airline, tour company, or other supplier as indicated in the travel documents, brochure, correspondence, or other communication. As the agent of the supplier, Zandra Black does not assume the responsibility for cancellation or substitution of service by the supplier, financial default of the supplier, refunds, unused services to be provided by the supplier, or any other obligation of the supplier pertaining to service or monies.
Zandra Black does not own or operate any entity which provides goods and services for your trip including lodging facilities, transportation companies, local ground handlers, tour operators, food service, or entertainment providers, etc. As a result, Zandra Black is not liable for any negligent or willful act or failure to act of any such person, or any other third party not under its control. Without limiting and foregoing, Zandra Black accepts no responsibility for any risk resulting in injury, delay, inconvenience, damage, or death, which results from criminal activity, weather or other acts of God, accidents, disease, epidemics or the threat thereof, illness, the provision of inappropriate medical attention or lack of access to the same, the demands of indoor or outdoor activities, strikes, political or civil unrest, overbooking, structural or other defective conditions in the hotels or other lodging facilities, acts of terrorism or threat thereof, insurrection or revolt, or any other event beyond its direct control. In addition, Zandra Black is not responsible for typographical or substantive errors in the descriptions hotels or programs.
Insurance Wavier

Zandra Black recommends that you purchase travel insurance to protect yourself from any unforeseen events as most health insurance policies will not cover you in a foreign country. (Please complete the BAPS Travel Insurance Waiver Form) *
I wish to accept trip insurance.
I wish to decline trip insurance.
Deposit

I understand deposits and fees are non-refundable without travel insurance. *
I understand.
Signature
Clear
Refunds, Changes, and Cancellations

Zandra Black has advised me of the supplier's refund charge and cancellation fees and penalties. I am aware that the travel event may be subject to the loss of up to 100% of the fare, should I elect to change or cancel this reservation. *
Yes, I understand the policy.
Yes, I understand but request additional information.
Signature
Clear
Passport, Visa, and Security Requirements

I have been advised of any passport, visa, and security requirements and have also researched any need for these documents and procedures for my travel event. *
Yes, I have been advised.
Yes, I have researched the need for these travel documents.
Signature
Clear
New Federal DOT Regulations
Post-Purchase Price Increases - Bans the practice of post-purchase price increases in air transportation on air tours unless the increase is due to an increase in government imposed taxes or fees. Federal law forbids the carriage of certain hazaedous materials, such as aerosols, fireworks, and flammable liquids, aboard the aircraft. If you do not understand these restrictions, contact your airline or go to www.faa.gov/about/initiatives/hazmat_safety.
Signature *
Clear
E-Signature
I have read the above paragraphs, initialed the applicable spaces, and agree to the terms as stated for all passengers in my group.
Name *
First Last
This is your electronic signature. Please check for the accuracy of this form prior to your submission.
Date Time *
MM / DD / YYYY
Name and contact number of someone not traveling with you.
In the event of an emergency, we would like to be able to contact someone you trust on your behalf. We will not use this information for any other purpose.
Please provide and emergency contact name and contact number.

Name
First Last
Phone
### - ### - ####
© 2016 KHM Consulting Inc. All Rights Reserved. KHM Travel Group® is a registered trademark of KHM Consulting Inc. California Seller of Travel Registration Number: 2089491-50. Registration as a seller of travel in California does not constitute the state's approval. Agent is not a participant in the Travel Consumer Restitution Fund. Florida Seller of Travel Reference Number ST37113. Iowa Seller of Travel Reference Number 960. Washington Seller of Travel Reference Number UBI 602 775 122. Cancellation and change penalties may apply to any travel arrangements booked. Details will be provided upon request.