PRESS TRIP PARTICIPATION FORM, AMERICAS

PROFESSIONAL INFORMATION

NAME (AS IT APPEARS ON PASSPORT

OR GOVERNMENT ID YOU CARRY)

TITLE

PUBLICATION OF ASSIGNMENT

CIRCULATION

STORY ANGLE

PUBLICATION DATE

PLEASE LIST ANY OTHER SPECIAL NEEDS

YOU HAVE REGARDING YOUR STORY
ASSIGNMENT(S)

PERSONAL INFORMATION

AIRPORT DEPARTURE CITY

DATE OF BIRTH

MAILING ADDRESS

HOME PHONE

CELL PHONE

E-MAIL

PASSPORT NUMBER

SPECIAL DIETARY NEEDS

ALLERGIES

FREQUENT FLYER NUMBER

PREFERENCE OF WINDOW OR AISLE SEAT

EMERGENCY CONTACT INFORMATION

NAME

ADDRESS

PHONE

I hereby approve [Insert Property Name] to book the above proposed flight on my behalf. I
acknowledge that I am responsible for any penalties or additional costs incurred during my
travels, including those pertaining to missed flights or flight changes. If I am for any reason (other
than medical or emergency circumstances), I understand that I may be expected to reimburse
the full amount to the purchasing party.

_____________________________
Signature

I understand and acknowledge that the purpose of this sponsored trip is to experience [Insert
Property Name] and the surrounding area in an effort to gather information for editorial
consideration or review.

_____________________________
Signature