Confidential Information Form

(This page is secure)
Your Confidential Information must be submitted to WTT no later than your tour’s Final Payment Due Date.
This personal information is held completely confidential and is only shared with your tour leader.
Required fields are indicated with an asterisk *
Information we need to know about you
First Name *

Last Name *

Email *

Confidential Information
List Prescription Medications you are currently taking (or indicate 'none') *



If yes, for what reason(s)

List any Medicine or Food Allergies you may have
(or indicate 'none') *

List any Dietary Restrictions you may have
(or indicate 'none') *

Do you have mobility or balance issues? *


 I have the following Mobility or Balance Issues (check all that apply)









Emergency Contact Information
Name of Contact Person *

Contact Relation to Traveler *

Primary Phone *
(please include area code)
 
Secondary Phone
(please include area code)
 

Special Instructions


Got Questions???
1-800-795-7135 in US
1-443-458-5634 outside US
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