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.

Attention New York Residents: New York residents are not eligible for Travel Confident protection program. To get further assistance, please call 800-243-3174.

Your Trip Information

Destination: New Hampshire & the White Mountains (Tour ID: 2191633)

Trip Dates: 8/23/2025 - 8/31/2025

Departing From: Hueytown, AL

Group Leader: Michelle

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 *

Room Type

Cost $0

First Name *

Last Name *

Room Type

Cost $0

First Name *

Last Name *

Room Type

Cost $0

First Name *

Last Name *

Room Type

Cost $0

Total Cost: $0

CREDIT CARD OR DEBIT CARD ARE THE ONLY ACCEPTABLE FORMS OF PAYMENT

CHECKS, MONEY ORDERS AND CASHIER CHECKS ARE NOT AN ACCEPTABLE FORM OF PAYMENT

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 #

Card Type

Expiration

Email Address

ATTN: CREDIT/DEBIT CARD HOLDER
The credit/debit cardholder who paid for the travel protection plan will be refunded on their credit/debit 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/debit cardholder by Travel Insured International.