AIL: Health and Travel Form
Please fill out this form with your health and travel information!
Participant Name
First and Last Name
Your answer
Health Information
Insurance Carrier
Your answer
Policy Number
Your answer
Group/Member ID Number
Your answer
Dietary Restrictions
Your answer
Medications You are Currently Taking
Your answer
Emergency Contact
Emergency Contact: First Name
Your answer
Emergency Contact: Last Name
Your answer
Emergency Contact: Relationship to Participant
Your answer
Emergency Contact: Daytime Phone Number
Your answer
Emergency Contact: Evening Phone Number
Your answer
Trip Equipment Information
Will you be bringing your own tent?
If you are bringing a tent, how many people does it hold comfortably?
Your answer
Will you be bringing your own tarp?
Arrival Information
Are you flying or driving?
If you are flying, which airport are you flying to?
Arrival Airline and Flight Number
Your answer
Date
Your answer
Arrival Time
Your answer
Departure Information
Departure Airport
Departure Airline and Flight Number
Your answer
Date
Your answer
Time of Departure
Your answer
What is your T-shirt Size?
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