Travel Registration Form, UCLA Dentistry Hawaii 2022

Main Travel Dates:

Saturday, June 25 or Sunday, June 26 to Saturday, July 2, 2022

University Travel
1888 Eucalyptus Road

Nipomo, CA 93444

University Travel UCLA Dentistry Desk: (818) 563-9235

Or general numbers; (818) 563-9808 (ext.201) Toll-Free Nationwide: (800)-821-5094

FAX: (818) 563-9842 email: ucladentistry@unitrav.com

Deposits may be paid by check or by credit card information below.
CST registration # 1015591-40

California Seller of Travel Information available here: http://www.unitravhawaii.com/CSTpage.html

Main Contact, First Name *

Last Name *

Number in Party *

Accompanied by (please list children's ages if 18 or under).

Name 2

Name 3

Name 4

Address, Line 1 *

Address, Line 2

City *

State *

Postal Code *

Day Phone *

Evening Phone

Email Address *

Enter again to confirm: *

Grand Hyatt Kauai Room Requirements *

Standard View	Pool View	Partial Ocean View
Deluxe Ocean View

Hotel Check-in Date: *

Hotel Check-out Date: *

Bedding preference (does not apply to suites) Note request only, not guaranteed.

One King Bed

Two Queen Beds

Flights: *

Not Required

Required

Home City Airport

Note regarding flights: Due to security requirements, please call our office at (800) 821-5094 x 201 or (818) 563-9235 with the following information: flight reservations now require passengers to use the full name exactly as shown on your picture identification including middle name(s). Passengers date of birth and gender are also required.

Rental Car *

Not Required

Required

Car Category if Required

Remarks/Special Instructions/Requests

0/500 characters

Secure Credit Card Information: (Please note - your card is not charged upon submission - we will charge it at the University Travel office once all of your reservations are confirmed).

Name on Card

Credit Card Type

Credit Card Number

Expiration Date (mm/yy)

3 or 4 digit security code:

Deposit Amount Authorized:

Thank you! You will receive an acknowlegment e-mail followed by a email confirmation package.