Are You Protected?

First Name *

Last Name *

Email Address *

Dates of Travel

Trip Supplier

Confirmation #

Total Trip Cost $

I have been offered and advised of travel protection/

trip insurance options and fees by my travel agent,

I accept and will purchase travel protection/

trip insurance for all trip participants.

Yes

If you wish to purchase a trip protection plan, please purchase it within 14 days of your first trip payment to cover the pre-existing conditions waiver and the supplier default conditions of the policy.

Travel Protection Waiver:

I decline the offer to purchase travel protection / trip insurance. I understand that I am solely responsible for any cancellation penalties and out-of-pocket expenses incurred. I will also make my own separate travel, medical and any other provisions in the event of an emergency while I am traveling. I also understand that I am not protected from loss in the event of any travel vendor, travel supplier or any travel-related operator default. This waiver confirms that I voluntarily decline travel insurance and travel protection insurance for the trip described above. I understand I am solely liable for all airline fees, supplier fees, and agency fees that may apply, and I hereby release Research Travel, Inc. and its agents from any and all liability related to the trip described above.

Yes

(Optional) Policy #

Purchased through (Insurance Company or supplier)

I have read this document; I understand this document and all consequences resulting from my decision to purchase or decline trip protection and trip insurance.

Yes

This waiver must be signed by each adult traveler 18 year of age or over.

Number of Travelers over 18 years of age *

First Name *

Last Name *

Date * +

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ALAKAZAM TRAVEL & CRUISE, INC.

330-467-0695

www.AlakazamTravel.com

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