International Insurance Society
47th Annual Seminar
June 19 – 22, 2010 Toronto

TRAVEL RESERVATION REQUEST FORM

All travel arrangements, including unique and exciting pre- and post-seminar plans, can be made through Protravel International, one of the country's leading travel management companies. Protravel has negotiated favorable and competitive rates for your airfare. Please complete the form below and submit it to Protravel International so we can help make your travel as smooth and pleasant as possible. Please make sure to enter your name as it appears on your government issued photo ID or Passport. Thank you!

Personal Information

First Name		Middle Name
Last Name		Title
Email Address:
Business Phone		Home Phone
Cell Phone
Gender:
Birthdate:

Guest Information

Guest's First Name		Guest's Middle Name
Guest's Last Name
Guest's Gender:
Guest's Birthdate:

Emergency Contact Information

In case of emergency, please contact:
Emergency Contact Phone:

Flight Request Information

Preferred Airline:
Frequent Flier Number:

Seat Preference:

aislewindow

Departure
Departure Airport:
Departure Date:
Preferred Departure Time:
Return
Return Airport:
Return Date:
Preferred Return Time:

Special Airline Requests:

If you are making a reservation for a guest for whom you are paying, please submit a separate form and then call Vicky Metcalfe at the number listed below with a major credit card for billing purposes.

Contact Information

Vicky Metcalfe
Executive Travel Specialist
Protravel International
515 Madison Avenue
New York, NY 10022
Phone 212.702.2672
Fax 646.792.4625
E-mail vickym@protravelinc.com

Important - please be advised that under the Secure Flight Final Rules,we are required to collect and send to the TSA, through the airlines, the following passenger information: Name exactly as it appears on your government-issued I.D. used when traveling (First, Middle & Last Name), Date of Birth, and Gender.

Thanks for using Protravel. Please make sure all the information provided is correct, and then click the FINISH button to submit your travel request, or print this form and Fax it to 646-792-4625. . For questions, changes or further information please email Vicky.Metcalfe@protravelinc.com, or call Vicky Metcalfe directly at 212-702-2672. Please print a copy of this for your records.

The information contained in this form will be used by Protravel International for our internal marketing and will not be sold to or shared with any third party organization.