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Protection Plan Application Form
Please fill out the Protection Plan Application Form below. You may add as many as 10 passengers to the form. Fields with an '*' indicate required fields. Upon completion click 'Submit My Application Form' to complete your application.

** Please enter the passenger who is paying as the first passenger.

Your Trip Information
Destination: Mount Rushmore, the Badlands & Black Hills of South Dakota (Tour ID: 2091967)
Trip Dates: 6/1/2024 - 6/9/2024
Departing From: Hueytown, AL Group Leader: Sharon

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 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
$1577 $1907 $1557
First Name* Last Name* Double Single Triple Reset? Cost
$1577 $1907 $1557
First Name* Last Name* Double Single Triple Reset? Cost
$1577 $1907 $1557
First Name* Last Name* Double Single Triple Reset? Cost
$1577 $1907 $1557

Total Cost: $0

Your Credit Card Information
*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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