Travel Insurance Form

1

Travel Insurance Form

**Form must be signed before travel documents are released**
2
Emergencies can happen when you least expect it. I highly recommend that you protect your vacation with a travel insurance policy. The cruise lines, airlines, hotels and tour operators all charge high penalties for cancellation, ranging from the full deposit to no refund at all. Another important fact to keep in mind is that that most health insurance policies will not cover you when you are out of the country. Your Travel Insurance will protect you in the following areas:

Trip Cancellation

Trip Delay

Trip Interruption

Missed Connection

Baggage Loss, Theft or Damage

Baggage Delay

Emergency Medical and Dental Expenses

Emergency Medical Transportation

24/7 Hotline Assistance

Please understand that I am not a registered insurance agent, and can not legally provide specific advice or information regarding insurance. For information, please feel free to contact the travel insurance company directly.
3
Please sign this acknowledgement to accept or decline the Travel Insurance that is being offered to you.* This field is required.
YES, I want to purchase Travel Insurance at time of making my trip deposit.
YES, I want to purchase Travel Insurance at time of making my final trip payment.
NO, I do not want to purchase Travel Insurance, and assume all responsibility.
4
Full Name* This field is required.
First Name
Middle Name
Last Name
Suffix
5
Phone Number* This field is required.
Area Code
Phone Number
6
E-mail* This field is required.
7
I have been advised of, and understand the benefits of Travel Protection Insurance. I understand that I do not have any coverage until 24 hours after this form has been signed and submitted.

Should I decline this protection, I understand that I will assume all financial responsibility for any expenses incurred as a result of being unable to travel, or travel disrupted for any reason as well as any medical expenses. I also understand that I must purchase Travel Insurance immediately to obtain maximum coverage, in order to be covered for any pre-existiing conditions travel insurance must be purchased within 14 days of paying the trip deposit, and before the final payment has been made, and it must cover full cost of all non-refundable trip arrangements.
8
Signature
Clear
9
Departure Date:
Date
Month
Day
Year
10
Please note that your vacation can not be booked until you have returned this form. Please submit as soon as possible.
11
Please verify that you are human* This field is required.
Should be Empty: