Insurance

Your Name*
Your Email*
Phone*
Date - Starting Trip*
Date Format: MM slash DD slash YYYY
Date - Ending Trip*
Date Format: MM slash DD slash YYYY
Protection Decline*
- Yes - I decline Protection
Declining to purchase the travel insurance offered to you could make you vulnerable to the following potential risks or financial loss that may be experienced during travel: Risk of Cancellation, Risk of Delay, Emergency Medical Risks and expenses, Delayed/Lost Baggage Risk.
Electronic Signature:*
By signing and submitting this document, I acknowledge that I have been offered the option of purchasing trip cancellation/interruption insurance. The risks for declining coverage have been explained to me by my Travel Advisor. If I choose to decline coverage, I understand that declining travel insurance means I will lose all benefits of coverage and I fully accept that risk. The parties agree that this agreement may be electronically signed. The parties agree that the electronic signatures appearing on this agreement are the same as handwritten signatures for the purposes of validity, enforceability, and admissibility. By signing my name below and submitting this form, I agree to the terms provided on this page, and understand this is a legally binding agreement.
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