October 2014 Fáilte Imports Irish Trip Sign-Up

Full Name Of Passenger *
Full Name Of Passenger
Please provide the name that is on your passport
Gender *
Date of Birth *
Date of Birth
Please provide the Date of Birth listed on your passport
Daytime Phone
Daytime Phone
Evening Phone
Evening Phone
Home Address *
Home Address
Emergency Contact *
Emergency Contact
Please provide the name of who we should contact in case of emergency
Emergency Contact Phone *
Emergency Contact Phone
Please specify your country of your citizenship
Passport Issue Date *
Passport Issue Date
Passport Expiration Date *
Passport Expiration Date
Type of Room *
If you are arranging your own air travel, please provide us with Airline, Flight Number and Arrival time
If you are arranging your own air travel, please provide us with Airline, Flight Number and Departure time

HOURS
Monday — Friday
10:00am — 4:30pm
Saturday
9am — 5pm
Sunday
CLOSED

Fáilte Irish Import Shop
113 South Upper Street
(Beside McCarthy's Irish Bar)
Lexington KY 40507-1645
Phone: 859-381-1498