Genetic Engineering and Society (GES) Center

CONTACT INFORMATION

Full Legal Name(Required)

Full Legal Name as shown on ID

Prefix First Middle Last Suffix

Email(Required)

Preferred Name

Preferred name

Pronouns

Kindly provide your pronouns or designation to address you most appropriately.

Phone(Required)

Mobile number preferred

PURPOSE OF VISIT

This field is hidden when viewing the form

Is your visit research related?

Event/Purpose of Visit(Required)

Include the date or date range if known, as well as the full project name and PI if research related. If the dates are flexible, please indicate your availability.

AIR TRAVEL & LODGING

The following information is required for GES to assist in booking air travel and/or lodging

Do you require air travel, lodging, and/or mileage that will be booked OR reimbursed by the GES Center?(Required)

Air Travel

Lodging

Mileage

None

Date of Birth(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Driver's License and/or Passport(Required)

Please upload a photo of your driver's license and/or passport. These will be deleted after travel has been completed.

Drop files here or

Max. file size: 64 MB.

NC State University Employee(Required)

Employee ID(Required)

US Citizen?(Required)

Country of Citizenship(Required)

Airport of Origin:

Include City/State and Country if International

Frequent Flier Number / Airlines

List in order of preference. Click the (+) to add rows.

Airline Name

FF#

TSA/KTN

TSA PreCheck Known Traveler Number Lookup (link opens in new tab/window)

ACCOMODATIONS

Dietary Preference(Required)

None

Vegetarian

Vegan

Kosher

Gluten-free

Other/Allergies

Other/Allergies(Required)

ADA Accommodations(Required)

Will you be needing ADA accommodations for air travel or hotel?

Yes

I will call airline/ hotel myself to arrange any specifics.

ADA Accommodations Requested

In compliance with the Americans with Disabilities Act, NC State will honor requests for reasonable accommodations made by individuals with disabilities. Please describe any needed accessibility accommodations below and we will follow up with you directly. Requests can be served more effectively if notice is provided at least 10 days before the event.

Questions/Comments

Optional

Genetic Engineering and Society Center

GES Travel Form

CONTACT INFORMATION

PURPOSE OF VISIT

AIR TRAVEL & LODGING

ACCOMODATIONS