New York
11:55 AM
London
4:55 PM 		Paris
5:55 PM 		Tokyo
1:55 AM 		Honolulu
6:55 AM
EMERGENCY CONTACT FORM

It is necessary for us to keep medical information on each of our tour participants in case of a medical emergency during the trip.  We ask that you fill out the form below and click submit, or download and mail or fax back the form at your earliest convenience prior to the tour.

To download the Emergency Contact Form please right click and save your preferred format below, and fax it to 516-922-4505, or mail it back to: OYSTER BAY TRAVEL CENTER, 53 Audrey Avenue, Oyster Bay, NY 11771.

Emergency Contact Form Adobe Acrobat PDF | Emergency Contact Form Microsoft Word

Thank you for your cooperation.
Your Name:
Email:
Emergency Contact Name:
Emergency Contact Address:
Emergency Contact Phone Number:
 
Name of medications you take and dosages:
Allergies to medications:
Name of Primary Doctor:
  Primary Doctor's Phone Number:
Primary Doctor Email:
Additional Comments:
  
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