FINAL ITALY SURVEY
Name: 


  1. Name of traveler:


  1. Using the final Italy roster (see email or website), choose three to five travelers whom you would prefer as roommates:


  1. Have you made special travel arrangements with Mr. Novotny, Mr. Gregory, and Mr. Rene Piard at A La Carte Travel? (For example: Will the traveler be joining late or leaving early? Will the traveler not be on one or both of the group flights? Etc.)
    Yes
    No


  1. If you answered YES to question #3, please provide all of the details of the special travel situations/arrangements, including locations, dates, times, names, European contact info (if available), etc.


  1. For travelers, which of the following meeting dates and times can you absolutely NOT attend--unless the date and/or time is changed?
    21 May (Tuesday): lunch meeting for student travelers;
    28 May (Tuesday): 6 PM - Presentations of Il Dottore Terms;
    4 June (Tuesday): 6 PM - Presentations of Il Dottore Terms;
    9 June (Sunday): 5 PM - Trip Dinner, Presentations, Details, etc.


  1. If you responded that you could not attend a meeting due to the date and/or time, please leave at least two other days and/or times that are good for you.


  1. Please select any that apply to you:
    peanut (any nut) allergy
    shellfish allergy
    wheat allergy
    vegitarian
    restrictive diet due to religious beliefs
    vegan


  1. If any of the above applies to you, please explain in detail.


  1. Do you have an special medical needs? If so, list and explain them here.


  1. What Credit Cards and ATM Cards will the traveler be taking? Please provide here the names and phone numbers of all "plastic money" companies.


  1. Has any of your emergency contact information changed? If so, please provide the new information.





Lance Novotny
ID