CONSULTANT TRAVEL CHECKLIST

Consultant's Name  Consultant Code 
Mailing Address  SS #
U.S. Citizen?   Yes       No

If NO, what nationality? 

If not a US Citizen, attach a BIODATA INFORMATION  REQUEST Form IAP-66 (you can obtain this form from UCT S130, ext. 3176)		 What type of VISA? 

Passport # 

Purpose and Dates of Visit 

Is the Consultant an employee of a UT Component?  Yes       No   If yes, name of institution: 
Do you want us to purchase airline ticket through BTA?   Yes      No    If NO, Consultant mus return ticket stub for reimburseement
Do you have an airline preference?

Continental     Southwest     American     Delta      Northwest      Other 
Do you need hotel accommodations?    Yes      No       Do you have hotel preference?  Yes        No

Warwick Park Plaza     Marriott Medical Center    Other 
Note:  Some hotel will direct-bill our department.
Car Rental?    Yes     No      If yes, what car rental company do you prefer? 
                                                       Avis      Advantage    Budget     Other   
Are you paying honorarium?    Yes      No      If yes, how much per day? 
Are you paying consultant's meals?  Yes       No


ACCOUNT NUMBER TO BE CHARGED FOR THESE EXPENSES   


Signature of Principal Investigator