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 (if applicable)

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 Arch/Roam Right 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