Membership Application

Please fill out all field that apply. ( Required fields labeled with * )

Applicants should be 18 years of age before they apply. If you have any questions please email us at: [email protected].

Please use the name as it appears on your passport. No nicknames please!

If you’d prefer to fill out this application offline, please download the PDF version, fill it out, and return the form to:

Global Elite Travel
18653 Ventura Blvd., #435
Los Angeles, CA 91356

Download Form

Membership Application Form

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Name
Format: Month/Day/Year
Is applicant conserved?
Current state issued photo ID?
Current passport?
Format: Month/Day/Year
Format: Month/Day/Year
All airlines require current state issued photo ID or a current passport for boarding any aircraft. A current passport is required for all international travel. For passport information and application forms go to the U.S. State Departments WEB Site at www.travel.state.gov/passport/index.html . There is information on where to get a passport and you can download the forms that you need.
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Living Situation
COGNITIVE/MENTAL STATUS
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Medical Insurance
Food Allergies
Seizures
Diabetes
Dietary Limitations/Restrictions
Vision
Hearing
Communication
Sign Language
Mobility
SOCIAL BEHAVIOR
Does applicant have a history of aggressive or destructive behavior?
SLEEPING HABITS
Roommates
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Self Care - Dressing
Self Care - Bathing
Self Care - Toileting
Self Care - Shaving
Self Care - Medication
Self Care - Eating
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Can applicant ride independently on the Metro Bus system?
Does the applicant have a Metro reduced fare TAP Pass?
Does the applicant have a ACCESS TAP Pass?
SWIMMING (select all that apply)
STREET SAFETY
MONEY SKILLS
Able to use the phone?
Does applicant consume alcoholic beverages?
Does traveler smoke?
Could applicant fly alone and have an escort meet them at airport?
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List all medications including: Name of Medication, Dosage, Times, and Side Effects.
Can applicant take over-the-counter pain medication?
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Person to contact in case of an emergency.
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PUBLICITY RELEASE AGREEMENT - I hereby give permission to Global Elite Travel to use my image (video, video capture or still photo) for publicity materials such as: Video, Brochure, Web Site, YouTube, Flyers, T-shirts, Photographs, Facebook and other social media.
Format: Day/Month/Year