Octapharma Plasma

Infrequent Traveler / Guest Traveler request form

This form MUST be filled out COMPLETELY (* = required field)
One form per traveler per trip

TRIP APPROVER – If Approved please forward this email to opi@goctm.com. If Rejected please contact the traveler.
To make changes after submission, please contact CTM @ 704-943-2965 / 844-605-7306 / opi@goctm.com
If different than traveler

Traveler Personal Information

IMPORTANT NOTE: Name MUST be EXACTLY as it appears on Traveler’s government-issued ID, including a middle name, initial, and suffix (i.e., John Doe II).



Check if you are visiting a Donor Center or office location.

Depart Date:*

Air Travel

Not applicable
IMPORTANT NOTE: If Traveler needs to be at a destination by 12:00 noon or earlier, please note that they may need to travel to the destination the day before. If the Traveler’s meeting/event does not conclude until 6:00 p.m. or after, and depending on flight availability, they may need an extra night’s hotel accommodation and leave the next morning to return to their original location.


This is a one-way trip.

Rental Car

Yes No
NOTE: Drivers must be 21 years of age, have a valid driver’s license, and be willing to accept the responsibility to drive a rental car.

Pick up

At Arriving Airport Other

Return


Larger vehicle for 3 or more Travelers
Return to departing airport Other

Hotel

Not applicable



King size bed preferred

Additional Comments

To make changes after submission, please contact CTM @ 704-943-2965 / 844-605-7306 / opi@goctm.com