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Travel Protection Plan Application Form


Please fill out the Travel Protection Plan Application Form below. You may add as many as 4 passengers to the form. Fields with an '*' indicate required fields. Upon completion click 'Submit My Application Form' to complete your application.

Your Trip Information

Destination: Mackinac Island (Tour ID: 2072470)
Trip Dates: 9/23/2024 - 9/27/2024
Departing From: Muncie, IN Group Leader: Cynthia

Travel Protection Plan Application Form

* After entering your name, please select your Occupancy: either 'Double', 'Single' or 'Triple' Occupancy. This is the cost of the trip for each person. Upon selecting your occupancy, after a brief delay, the Cost of Travel Protection will appear to the right. If you wish to remove a person, click the bubble under 'Reset'? to remove the person on that line.

First Name* Last Name* Double Single Triple Reset? Cost
$769 $948 $749
First Name* Last Name* Double Single Triple Reset? Cost
$769 $948 $749
First Name* Last Name* Double Single Triple Reset? Cost
$769 $948 $749
First Name* Last Name* Double Single Triple Reset? Cost
$769 $948 $749

Total Cost: $0

Your Credit Card Information

ATTN: CREDIT CARD HOLDER:
The credit cardholder who paid for the travel protection plan will be refunded on their credit card if the plan is cancelled within 90 days of purchase. If 90 days after the date of purchase of the travel protection plan, a refund check will be issued to the credit cardholder by Travel Insured International.
*First Name: *Last Name:
*Address: Suite/Bldg:
*City: *State/Zip:
*Phone Number:  (NOTE: Please only use numbers, no characters)
*Credit Card #: *Credit Card:
*Expiration:
*Email Address:   (Ex: [email protected])
 




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