|
Trip
Name__________________________________________
Date of
trip__________________________________________
Departure
Location___________________________________
Deposit Amount
_________
Insurance (Optional)
_________
Total
_________
Last
Name__________________________________________
First
Name__________________________________________
Telephone__________________Birthdate__________________
Address____________________________________________
City____________________State_______Zip
Code_________
Email______________________________________________
Roommate’s
Name___________________________________
Dietary / Medical
Restrictions___________________________
__________________________________________________
Travel Insurance
We believe that your upcoming trip
is a significant investment that you
should protect. In the event that
you decline to purchase travel
protection insurance, you are
assuming any financial loss
associated with your travel
arrangements. Pre-existing
conditions included if insurance is
paid with deposit. You must be able
to travel at time of registration.
Please indicate your decision in the
space provided below:
YES_____ I elect to purchase Travel
Protection.
(Please include payment with
deposit.)
NO______ I decline to purchase
Travel Protection
I have read the Master Terms &
Conditions and I agree to be bound
by them.
Client Signature_______________________Date____________
|
