Contact Information

Preferred Name (If different from first name)
Country*
Email*
Confirm Email*
Phone*

Passport Information

Name (Enter name as it appears on your passport)*
Passport Number (PLEASE NOTE: Expiration date must be greater than 6 months from the date of travel.)*
Country of Citizenship*
Date of Birth (MM/DD/YYYY)*
Place of Birth*

Spouse's Passport Information (If Applicable)

Name (Enter name as it appears on spouse's passport)
Passport Number (PLEASE NOTE: Expiration date must be greater than 6 months from the date of travel.)
Country of Citizenship
Date of Birth (MM/DD/YYYY)
Place of Birth
Preferred Name (If different from Passport)

Dietary Restrictions

Dietary Restrictions for you (and/or spouse)

Emergency Contact

Please provide an emergency contact name and phone number(s) for a person outside the CMI Discover Trip traveling party.

Emergency Contact*
Emergency Contact Phone*
Emergency Contact Secondary Phone

Communications Preference

As the CMI Discover Trip approaches, we will be sending you additional information relevant to our trip. Please indicate your preference as to whether you would like to receive printed or electronic (PDF) copies of trip materials.

Thank You!

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