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New 11/12/23 Revised 11/12/23

**E-mail completed profile to <kelly.mccoy@navigant.com> or fax
303-444-2175**

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<col style="width: 3%" />
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<col style="width: 0%" />
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<col style="width: 12%" />
<col style="width: 5%" />
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<tbody>
<tr class="odd">
<td colspan="18"><strong>DEPT. OF COMMERCE (NOAA) - INDIVIDUAL TRAVELER
PROFILE</strong></td>
</tr>
<tr class="even">
<td colspan="11">TRAVELER: <strong>(Last)       (First)
     </strong></td>
<td colspan="7">TITLE: <strong>     </strong></td>
</tr>
<tr class="odd">
<td colspan="11">FEDERAL AGENCY:      </td>
<td colspan="7">DIVISION NAME:<strong>     </strong></td>
</tr>
<tr class="even">
<td colspan="18">ADDRESS, FLOOR, ROOM: <strong>     </strong> CITY,
STATE, ZIP: <strong>     </strong></td>
</tr>
<tr class="odd">
<td colspan="13">SOCIAL SECURITY #: <strong>     </strong></td>
<td colspan="5">BUREAU CODE (2 Digits): <strong>     </strong></td>
</tr>
<tr class="even">
<td colspan="13">BUSINESS PHONE: <strong>     </strong></td>
<td colspan="5">BUSINESS FAX: <strong>     </strong></td>
</tr>
<tr class="odd">
<td colspan="13">HOME PHONE (EMERGENCIES ONLY):
<strong>     </strong></td>
<td colspan="5">EXTERNAL E-MAIL ADDRESS (required):
<strong>     </strong></td>
</tr>
<tr class="even">
<td colspan="18"><strong>TRAVEL ARRANGER INFORMATION (If
Applicable)</strong></td>
</tr>
<tr class="odd">
<td colspan="18">NAME: <strong>     </strong> PHONE:
<strong>     </strong> FAX: <strong>     </strong> EMAIL:
<strong>     </strong></td>
</tr>
<tr class="even">
<td colspan="18"><strong>Airline Ticket Payment: Agency Centrally Billed
Charge Card (Complete Below if on Individual Government Issued Charge
Card)</strong></td>
</tr>
<tr class="odd">
<td colspan="18"> Visa MC Primary: <strong>     </strong> Exp:
<strong>     </strong>/ <strong>     </strong></td>
</tr>
<tr class="even">
<td colspan="18"></td>
</tr>
<tr class="odd">
<td colspan="18"> Visa MC Secondary: <strong>     </strong> Exp.:
<strong>     </strong> / <strong>     </strong></td>
</tr>
<tr class="even">
<td colspan="2"><strong>Seating:</strong></td>
<td colspan="2"></td>
<td colspan="4">Non-smoking</td>
<td colspan="2"></td>
<td colspan="3">Aisle</td>
<td></td>
<td colspan="2">Other <strong>     </strong></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="4">Smoking</td>
<td colspan="2"></td>
<td colspan="3">Window</td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="18"></td>
</tr>
<tr class="odd">
<td colspan="2"><strong>Special Meal Request:</strong></td>
<td colspan="2"></td>
<td colspan="4">Low Sodium</td>
<td colspan="2"></td>
<td colspan="3">Kosher</td>
<td></td>
<td colspan="2">Low Calorie</td>
<td colspan="2">Other:</td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="4">Low Fat/Chol</td>
<td colspan="2"></td>
<td colspan="3">Seafood</td>
<td></td>
<td colspan="2">Vegetarian</td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="4">Fruit Plate</td>
<td colspan="2"></td>
<td colspan="3">Diabetic</td>
<td></td>
<td colspan="2">Raw Vegetarian</td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="18"><strong>Airline Frequent Flyer Numbers:</strong></td>
</tr>
<tr class="odd">
<td>United</td>
<td colspan="6">MILEAGE PLUS</td>
<td colspan="11"><strong>     </strong></td>
</tr>
<tr class="even">
<td>American</td>
<td colspan="6">AADVANTAGE</td>
<td colspan="11"><strong>     </strong></td>
</tr>
<tr class="odd">
<td>America West</td>
<td colspan="6">FLIGHTFUND</td>
<td colspan="11"><strong>     </strong></td>
</tr>
<tr class="even">
<td>Continental</td>
<td colspan="6">ONEPASS</td>
<td colspan="11"><strong>     </strong></td>
</tr>
<tr class="odd">
<td>Delta</td>
<td colspan="6">SKYMILES</td>
<td colspan="11"><strong>     </strong></td>
</tr>
<tr class="even">
<td>Northwest</td>
<td colspan="6">WORLDPERKS</td>
<td colspan="11"><strong>     </strong></td>
</tr>
<tr class="odd">
<td>TWA</td>
<td colspan="6">FLIGHT BONUS</td>
<td colspan="11"><strong>     </strong></td>
</tr>
<tr class="even">
<td>U.S Air</td>
<td colspan="6">DIVIDEND MILES</td>
<td colspan="11"><strong>     </strong></td>
</tr>
<tr class="odd">
<td>Other Airline:</td>
<td colspan="17"><strong>     </strong></td>
</tr>
<tr class="even">
<td colspan="18"><strong>Car Rental Programs:</strong></td>
</tr>
<tr class="odd">
<td colspan="2">Alamo</td>
<td colspan="7">Quick Silver</td>
<td colspan="9"><strong>     </strong></td>
</tr>
<tr class="even">
<td colspan="2">Avis</td>
<td colspan="7">Wizard Number</td>
<td colspan="9"><strong>     </strong></td>
</tr>
<tr class="odd">
<td colspan="2">Budget</td>
<td colspan="7">Budget Express</td>
<td colspan="9"><strong>     </strong></td>
</tr>
<tr class="even">
<td colspan="2">Dollar</td>
<td colspan="7">Gold Plus</td>
<td colspan="9"><strong>     </strong></td>
</tr>
<tr class="odd">
<td colspan="2">Hertz</td>
<td colspan="7">#1 Club</td>
<td colspan="9"><strong>     </strong></td>
</tr>
<tr class="even">
<td colspan="2">National</td>
<td colspan="7">Emerald Club</td>
<td colspan="9"><strong>     </strong></td>
</tr>
<tr class="odd">
<td colspan="4">Special Car Rental Request:</td>
<td colspan="14"><strong>     </strong></td>
</tr>
<tr class="even">
<td colspan="18"></td>
</tr>
<tr class="odd">
<td colspan="18"><strong>Frequent Hotel Stay Programs:</strong></td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="7"></td>
<td colspan="9"><strong>     </strong></td>
</tr>
<tr class="odd">
<td colspan="2">Hilton</td>
<td colspan="7">HHONORS</td>
<td colspan="9"><strong>     </strong></td>
</tr>
<tr class="even">
<td colspan="2">Holiday Inn</td>
<td colspan="7">PRIORITY CLUB</td>
<td colspan="9"><strong>     </strong></td>
</tr>
<tr class="odd">
<td colspan="2">Hyatt</td>
<td colspan="7">GOLD PASSPORT</td>
<td colspan="9"><strong>     </strong></td>
</tr>
<tr class="even">
<td colspan="2">Marriott</td>
<td colspan="7">HONORED GUEST</td>
<td colspan="9"><strong>     </strong></td>
</tr>
<tr class="odd">
<td colspan="2">Ramada</td>
<td colspan="7">GUEST AWARDS</td>
<td colspan="9"><strong>     </strong></td>
</tr>
<tr class="even">
<td colspan="2">Sheraton</td>
<td colspan="7">CLUB INTL</td>
<td colspan="9"><strong>     </strong></td>
</tr>
<tr class="odd">
<td colspan="2">Stouffer/ Westin</td>
<td colspan="7">STARWOOD</td>
<td colspan="9"><strong>     </strong></td>
</tr>
<tr class="even">
<td colspan="2">Other</td>
<td colspan="7">     </td>
<td colspan="9"><strong>     </strong></td>
</tr>
<tr class="odd">
<td colspan="2">Other</td>
<td colspan="7"></td>
<td colspan="9"><strong>     </strong></td>
</tr>
<tr class="even">
<td colspan="18">Hotel Guarantee Visa MC Amex DC #:
<strong>     </strong> Exp: <strong>     </strong>/
<strong>     </strong></td>
</tr>
<tr class="odd">
<td colspan="5">Special Room Request:</td>
<td></td>
<td colspan="4">Smoking</td>
<td colspan="2"></td>
<td colspan="6">Non-smoking</td>
</tr>
<tr class="even">
<td colspan="2">Other Hotel Requests:</td>
<td colspan="16"><strong>     </strong></td>
</tr>
<tr class="odd">
<td colspan="18"></td>
</tr>
<tr class="even">
<td colspan="5"><strong>Name as it Appears on Passport:</strong></td>
<td colspan="10"><strong>     </strong></td>
<td><strong>Passport #:</strong></td>
<td colspan="2"><strong>     </strong></td>
</tr>
<tr class="odd">
<td colspan="3"><strong>City/Country of Issue:</strong></td>
<td colspan="12"><strong>     </strong></td>
<td colspan="2"><strong>Expiration Date:</strong></td>
<td><strong>     </strong></td>
</tr>
<tr class="even">
<td colspan="18"></td>
</tr>
<tr class="odd">
<td colspan="18"><p><strong>Please keep a copy of this profile for your
records.</strong></p>
<p><strong>Any changes or deletions may be called in to any Navigant
International/Professional Travel Agent.</strong></p></td>
</tr>
</tbody>
</table>