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') *

Are you currently under a Doctor's Care? * YesNo

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 No Mobility or Balance Issues

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

Slow Walker
Tire Easily when walking
Difficulty Climbing Stairs
Require a cane or other assistance with walking or balance
Unable to manage my own luggage and carry-on without assistance
Other mobility or balance issues (please describe)

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 Is there anything else you need to let us know about to insure you have a safe and fun trip?

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