Your Info :: Nelson Travel Broker

Traveller's Information Form

Group name (if relevant)

Frequent Flyer Member?

TItle Required

Surname Required

First Names Required

Post Code Required

Date of Birth Required

Email Required

Phone (Mobile) Required

Postal Address Required

Phone (Day)

Phone (Evening)

Next of Kin

Kin Phone (Home)

Passport Nationality Required

Kin Phone (Work)

Passport Number

Passport Issued At

Passport Issued Date

Passport Expiry Date

NZ Returning Resident Visa?

Place of Birth

Mobility or Health Issues Required

Please specify any mobility or health issues

Medical Conditions Required

Specify Medical Conditions

Specify Medical Conditions

Special Meal Requirements?

Specify Meal Requirements

Any Criminal Convictions Required

Specify Criminal Convictions

Airline 1

Membership/PIN 1

Airline 2

Membership/PIN 2

Any other comments

Keep me up to date with travel news and deals

Yes please