Title:

First Name:

Last Name:

Company Name:

Department:

E-mail:

Travel Arranger:

Home Phone:

Office Phone:

Extension:

Fax:

Home Address:

City:

Province:

Postal Code:

Emergency Contact:

Phone:

Airline Preferences:

Seating Preference:

Type of Aircraft Preferred:

Special Meals Required:

Airline Frequent Flyer

PLEASE NOTE

Enrollment name must match traveler's name exactly in order to receive mileage credit from airline.

Airline:

Membership Number:

Name: (as it appears on membership)

Physical Challenges or Personal Preferences

(Please provide any relevant information that may assist us in meeting your special travel requirements.)

Preferred Hotels

Hotel Name:

City or Region:

Room Type:

Membership ID #:

Smoking or Non Smoking?

Special Requirements?

Blacklisted Hotels?

Preferred Car Rental Program

Rental Company:

City or Region:

Car Type:

Membership ID #:

Citizenship Information

Passport Number:

Expiry Date:

Nationality:

Credit Card Numbers for Billing

Card Company:

Card Number:

       Expiry Date:

Airline Tickets:   

Hotel Guarantee:   

Personal Travel:   

** Note: If you prefer, please call Mills Travel during regular business hours
at (403) 342-2022 or 1-800-773-9687, to provide us with this information.

  I authorize Mills Travel to use the above credit card(s) for travel services and/or hotel guarantee.

We have created this statement in order to demonstrate our firm commitment to privacy. We will not 
disclose or sell any of your personal information, including your name, address, credit card number or email address,
 to any third party. We use this information strictly for internal purposes to help serve you more efficiently.