EmailMe Form - e4 Travel - Travel Protection Waiver

Traveler's Name *

First Last

Email *

Phone *

### - ### - ####

Coverage Start Date *

MM / DD / YYYY

Coverage End Date *

MM / DD / YYYY

Brief Description of
Travel Package

AND/OR

Reservation Number(s) *

At the time of Initial Deposit and/or Payment please confirm you understand each of the following: *

I understand the cancellation and change fees related to my purchase.

I understand travel protection/insurance may protect me from possible loss of money due to supplier bankruptcy/default.

I understand travel protection/insurance may cover accidents, sickness and/or death.

I understand travel protection/insurance may cover baggage loss, medical expenses, and emergency air transportation costs.

Travel Protection Option *

I ACCEPT Travel Protection/Insurance Coverage

I DECLINE Travel Protection/Insurance Coverage

I am UNDECIDED (I will notify e4 Travel and Events of my selection within 6 days of initial deposit, otherwise my coverage options may be limited).

This form is submitted on *

MM / DD / YYYY

This form is submitted by *

First Last

If you are the lead traveler of a group booking, do you accept these terms on behalf of the other travelers in your group?

Signature *