Travel Booking Request Form

Please fill in the fields below as completely as possible.

REQUIRED FIELDS:

First name (AS IT APPEARS ON YOUR PASSPORT OR I.D.)
Middle name (AS IT APPEARS ON YOUR PASSPORT OR I.D.)
Last name (AS IT APPEARS ON YOUR PASSPORT OR I.D.)
Date of Birth
Your e-mail and telephone, if not a BPC member
Dates of travel
Destination(s)
Reason for trip
Cost Center:
Cost Center, if not on pull-down list:


1. I NEED A TRAVEL ADVANCE: Yes No

If no, skip to next question. If yes, fill in table below:

Amount requested:
Date required by:

2. I NEED AIRPLANE TICKET: Yes No

If no, skip to next question. If yes, fill in table below:

Date of Departure (mmddyy)
City of Departure
Destination Airport
Date of Return (mmddyy)
Seating preference
Time of day for departure flight
Time of day for return flight
Preferred Airline
Frequent flyer number, if avail.

*NOTE: You cannot use an electronic ticket if charging to the MBL credit card. You will have to get a paper ticket. If you want an electronic ticket, you will have to use your own credit card and apply to the MBL for reimbursement.

If you have a more complicated flight, please outline below what you need:


3. I NEED LODGING: Yes No

If no, skip to next question. If yes, fill in table below:
Hotel name
Hotel telephone
Date of arrival (mmddyy)
Number of nights lodging needed
Number of persons in room
Smoking? Yes No
Bed size
Provide conference name, if there is a special rate

* NOTE: You will have to pay for the hotel on your own credit card and apply for reimbursement from the MBL; however, we will hold the reservation using the MBL credit card.

Additional comments:


4 I NEED A RENTAL CAR: Yes No

If yes, fill in table below:
Size:
Time/date of pick-up
Time/date of return
Will you return car to same location? Yes No
If different location, where?
Rental car company preferred
Membership number, if any
Promotional/discount code, if any




Please e-mail Rich Fox at rfox@mbl.edu if you have any problems with this form.