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UFCW 2023 Convention Travel Request Form

Date(s): 24 April – 28 April 2023 The Mirage 3400 S Las Vegas Blvd Las Vegas, NV 89109

4520 Old Columbia Pike Annandale, VA 22003 (703) 941-8186 Office (202) 478-1633 Fax Email: ufcwlas@mtsunion.com

Personal Information

(Name must be as it appears on your PASSPORT or DRIVERS LICENSE)

First Name(required)

Middle Name or Initial

Last Name(required)

E-mail(required)

Home/Cell Number(required)

Work Number

Date of Birth / Gender / TSA Information

Date of Birth(required)

Gender(required)

Male

Female

TSA Pre Check Number

Global Entry Number

Redress Number

Attending Convention As:

Delegate

Alternate Delegate

International Executive Vice President

International Vice President

Region, Division and Council Presidents (US & Canada)

Constitution Committee Member

Elections, Rules, Credential Committee Chair & Co-Chair

Retired International Officer

Speaker

Exhibitor

Crew

Staff

Seat Preference

Aisle

Center

Window

Departure Info

One-Way

Round Trip

Date(required)

Preferred Time

Departure City and State(required)

Arrival City and State(required)

Special Remarks

Return Info

Date(required)

Preferred Time

Departure City and State(required)

Arrival City and State(required)

Special Remarks

Do you have specific Airline and Flight Number information you would like to provide us with?

Yes

Specific Airline Number Information

(Complete this section only if you have researched your travel and are requesting a specific itinerary, which includes your preferred Flight Numbers)

Departure Airline

Departure Flight Number

Return Airline

Return Flight Number

Security Key

Type the characters(required)

This field should be left blank