EmailMe Form - Jewel Sky Getaways - Vacation Protection Election

Traveler/Client's Name *

First Last

Travel Departure Date - Coverage

MM / DD / YYYY

Travel Return - Coverage

MM / DD / YYYY

Describe Your Vacation Package:
Example - Cancun,
Family of 4,
R/T Airfare,
All-Inclusive Resort,
5 Days, etc.

At the time of Initial Deposit and/or Payment please read and then check to indicate understanding of each of the following: *

I have been ADIVISED of the cancelation penalties related to my purchase.

I UNDERSTAND that travel protection can protect me from possible loss of money due to supplier bankruptcy/default.

I also UNDERSTAND that Travel Protection can cover accidents, sickness and/or death.

I further UNDERSTAND that Travel Protection can cover baggage loss, medical expenses, and emergenct air transportation costs.

Travel Protection Option *

I ACCEPT TRAVEL PROTECTION COVERAGE

I DECLINE TRAVEL PROTECTION COVERAGE

I AM UNDECIDED (MUST PURCHASE WITHING 21 DAYS OF INITIAL DEPOSIT TO RECEIVE PRE-EXISTING CONDITIONS COVERAGE)

This form is submitted on *

MM / DD / YYYY

This form is submitted by *

First Last

Digital Signature

I declare the above information above is true *

A minimum of 2 characters is allowed, currently: 0.