Teleportation to a new time frame request form

CHECK JUST ONE BOX:                                                                   ATTACH 

1 Forward in time                                                    PASSPORT                          

1 Backward in time                                                PHOTO          

Time Destination Requested:  ____/____/_______             HERE

                                                                                                                       MONTH           DAY                 YEAR

Location Requested: _____________________

                                                                                                        EARTH LOCATIONS ONLY

Full Name of time traveller: ___________________________________

Due to the erratic nature of John Titor’s busy schedule, The Titor Institute cannot guarantee specific launch times. Once this request form has been processed, it may take up to five years to activate your time travel adventure. Be sure to have your return trip time travel coin on your person at all times. You will receive a return trip post card upon landing at your new time destination. Thanks so much for choosing the Titor Time Travel Institute!