FIDL Travel Request Form – Harris County Public Defender's Office

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FIDL TRAVEL REQUEST FORM

TRAVELER'S INFORMATION

Prefix

First Name *

Middle Name *

Last Name *

Date of Birth *

Month *

Day *

Year *

Gender *

Email Address *

Phone *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Country

Training Program Attending

Training Location (City/State)

FLIGHT INFORMATION

Flight Option *

DEPARTING FLIGHT

Airline

Flight Date

# of Bags Check In

Flight Time

From (City/State)

Airport Code

Flight #

Flight Time

From (City/State)

Airport Code

Flight #

RETURN FLIGHT

Airline

Flight Date

# of Bags Check In

Flight Time

From (City/State)

Airport Code

Flight #

Flight Time

From (City/State)

Airport Code

Flight #

Special Flight Assistance (Peanut Allergy, Wheelchair, Blind/Low Vision, Deaf/Hard of Hearing, etc.)

ACKNOWLEDGEMENT

I certify that the information I have given in this application is my own, and is true, correct, and complete to the best of my knowledge.

Requestor Full Name *

Date *

Harris County PDO
1201 Franklin St.
13th Floor
Houston, TX 77002

Hours
8:00 AM - 5:00 PM

Main: (713) 274-6700

Facsimile: (713) 368-9278

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