Travel Forms - Make The World Your Playground

JR Travelers & TRIP REGISTRATION

One attendee per form. Please repeat process for additional travelers.

Trip Name & Date *

Your Name *

First

Last

Date of Birth

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Confirm Email

Name of Roommate (if double occupancy)

Emergency Contact Name, Relationship and Phone Number (someone not traveling with you)

Trip Insurance *

I hereby accept trip insurance and agree to the terms and conditions of the program.
I hereby 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.

Trip Insurance Notification: (Signature REQUIRED) *

Trip insurance is strongly recommended by TOTAL ACCESS TRAVEL LLC to protect clients from certain situations that could cause this trip to be cancelled, interrupted, and/or delayed resulting in a loss of time and monies. We use Chubb Travel Protection and the cost is per person per event. You have the option of searching elsewhere and showing us proof of coverage prior to final payment.

Date *

Website