NYU Stern Thailand Registration

To register for the Thailand Trek, please fill out all of the information below as it appears on your travel documents. All participants must complete the following form to attend the trek.

Name *

First

Middle

Last

Please list name exactly as it appears on your passport.

Email *

Phone *

Date / Time *

Gender *

Emergency Contact Name *

Emergency Contact Phone *

Dietary Restrictions *

Medical Requirements *

Passport Number *

Country of Citizenship *

Passport Issue Date *

Passport Expiration Date *

Flight Information

Please list your flight information below. If you do not have this available, it will be required prior to traveling.

Departure Airline

Departure Flight Number

Arrival Date

Arrival Time

Return Flight Airline

Return Flight Number

Flight Departure Date from Thailand

Flight Departure Time from Thailand

Travel Insurance

All group participants are required to have individual health travel insurance. If you don't have your insurance information at this time, you will be required to send it prior to traveling.

Insurance Carrier

Policy Number

Comment

Flight Information

Travel Insurance

Title