VTA Member Information

Thank you for joining my Virtual Travel Assistant program. All information is kept confidential. Please fill out the form below for each registered member, and then click the Submit Information button. In addition to the information below, I will also need a copy of your Passport photo page, and certain passwords that I will request in a separate email (so login and password aren’t connected in the same message).

Virtual Travel Assistant Member Information (* indicates required field)
Please note that additional information will be required to complete your Member Profile.
Do NOT send any passwords with this information.

Your name*

Your full legal name*

Your mailing address (part 1)*

Your mailing address (part 2)

Your City, State/Province, Zip/Code, Country (USA or CANADA)*

Telephone # for calls, texts, etc.*

Your email address*

LOYALTY PROGRAMS
Airlines (if more than 4, submit in a separate email):
Airline Loyalty Program 1 Name:

Airline Loyalty Program 1 Member Number:

Airline Loyalty Program 2 Name:

Airline Loyalty Program 2 Member Number:

Airline Loyalty Program 3 Name:

Airline Loyalty Program 3 Member Number:

Airline Loyalty Program 4 Name:

Airline Loyalty Program 4 Member Number:

Hotels (if more than 4, submit in a separate email):
Hotel Loyalty Program 1 Name:

Hotel Loyalty Program 1 Member Number:

Hotel Loyalty Program 2 Name:

Hotel Loyalty Program 2 Member Number:

Hotel Loyalty Program 3 Name:

Hotel Loyalty Program 3 Member Number:

Hotel Loyalty Program 4 Name:

Hotel Loyalty Program 4 Member Number:

If you have enrolled another member in the VTA program, re-submit this form with that person's information. Thank you.