Emergency Contact Form

Emergency Contact Form

Please provide at least two contacts
We require our travelers to provide us with at least two emergency contacts we can contact in case of an emergency while you are traveling with our group. Getting caught in another country without help is a scary reality for many travelers and their emergency contacts. It’s not often we plan for what emergency contacts NEED if called upon. Your emergency contact should be getting ready for your big trip, too, in case you need them. They are your lifeline.

Team eBiz Travel | info@ebiztravel.net
Travelers' Name*

First NameLast Name
Travelers' Email Address*
example@example.com
Which Trip Are You Booked On?*
EMERGENCY CONTACT INFO
Emergency Contact #1*

First NameLast Name
Email Address
Phone Number*

Area CodePhone Number
Relationship with Contact*

ParentChildSiblingWifeHusbandFriendOther
Emergency Contact #2*

First NameLast Name
Email Address
example@example.com
Phone Number*

Area CodePhone Number
Relationship with Contact*

ParentChildSiblingWifeHusbandFriendOther
Emergency Contact #3

First NameLast Name
Email Address
example@example.com
Phone Number

Area CodePhone Number
Relationship with Contact

ParentChildSiblingWifeHusbandFriendOther
TRAVEL INSURANCE INFORMATION

"Optional"
If you purchased travel insurance and would like to add this information, please do so by completing the below questions. If not then just hit the submit button.

In case of an emergency, this information can be shared in case you have to be hospitalized while in the country you are visiting.
Name of Travel Insurance Company
e.g. Allianz, World Nomads, etc.
Policy Number
Check your policy.
Plan Number/Plan Name (if applicable)
Check your policy.
Travel Insurance Customer Service Phone Number (Please provide international contact number if traveling outside the United States)

Area CodePhone Number
Terms and Conditions*
eBiz Travel 967 Kendall Drive #224 San Bernardino CA 92407 Ph: 800-906-6756 info@ebiztravel.net
Should be Empty:

Emergency Contact Form

EMERGENCY CONTACT INFO

TRAVEL INSURANCE INFORMATION