Dr. Mr. Mrs. Ms. ________________________________ Birthdate ___________

                                                (Print complete name as shown on your passport)

            Passport No. ____________ Expires ________ Occupation  ______________

    (All U.S. citizens require a passport for travel to Japan that is valid three months longer than your scheduled return date.)

Dr. Mr. Mrs. Ms. __________________________________ Birthdate ___________

                                                (Print complete name as shown on your passport)

            Passport No. ___________ Expires ________ Occupation  ____________

   (All U.S. citizens require a passport for travel to Japan that is valid three months longer than your scheduled return date.)

Home Address____________________City______________  State ____ Zip______

Mailing Address __________________ City ______________  State ____ Zip______

                                (If final documents are sent by UPS, they cannot deliver to a P.O. box.)

Phone: Home _______________    Business _______________  Cell ____________

Email address: _________________________________   Fax: ________________

Would you like Yamato Travel Bureau to assist you with air arrangements?  Yes __   No__

JAL Mileage Number(s)  _______________    _________________________

Globael Entry Number(s) ______________    _________________________ 

If you arrange your own air, please let us know as soon as possible.  Send us your flight itinerary once it’s confirmed.

Hotel room preference:  Smoking _______      Non-smoking _______  

Other special requests: _________________________________________________________________

Do you have any special dietary, medical or physical needs of which we should be aware? _________________________________________________________________

Please provide name, relationship, and phone number of person to contact in case of emergency: _________________________________________________________________

FOR CREDIT CARD PAYMENT, PLEASE PROVIDE: 

Card number: _____________________________________
Expiration: _______________ Security number:______________
Cardholder name: ______________________________________________

Billing address if different from home address: _________________________