Mr. Mrs. Ms.____________________________________________ Birth Date _________________

Please use legal name – as shown on passport – A valid passport is required)

Passport Number _______________ Date of Issue _____________ Expiration Date _____________
City, State, Country of Issuance ____________________________Citizenship _________________

 

 

Preferred Mailing Address _________________________City________________ State___ Zip _______
(Final documents may be sent by UPS, please advise most convenient delivery address for this purpose.)

Phone number: _________________ Home Cell ______________ Business ______________

E-mail address: _________________________________________________

Airline Mileage Program Membership Numbers:
Airline  ________________________________Account Number _________________
Airline ________________________________Account Number _________________

Airline ________________________________Account Number _________________

If you are not a member of any airline programs, would you be interested in enrolling? Yes ____ No ____

Airline seat preference – aisle / window (request only) _____________________

Please advise if you are celebrating a special occasion (birthday, anniversary, etc. and specify date and event. _______________________________________________________________

 

Please advise if there are any special dietary, medical or physical problems of which we should be aware.  _______________________________________________________________

Contact information in case of emergency:
Name _______________________Relationship ______________ Phone No. __________________
Name _______________________Relationship ______________ Phone No. __________________

PLEASE SEND COMPLETED APPLICATION AND DEPOSIT OF $500.00 PER PERSON,
ALONG WITH A PHOTO COPY OF YOUR VALID PASSPORT TO:
YAMATO TRAVEL BUREAU®
(California Seller of Travel Registration No. 1019309-10)
250 East First Street, Suite 1112
Los Angeles, CA 90012
Phone: (213) 986-2175 or (310) 532-4461      E-mail: sharon@yamatotravel.com