EmailMe Form - TRAVEL INSURANCE WAIVER-

PRIMARY TRAVELER Responsible for Travel Package must complete for group: ________________________________________________________________

Primary Traveler Full Name- *

Prefix First Last Suffix

PLEASE REVIEW CAREFULLY>>>

As Primary Traveler for my reservation***, I understand that by completing and submitting this form, I am acknowledging that I have received and reviewed insurance information and I understand that Travel Protection Insurance can shield me from possible loss of money due to: supplier bankruptcy/default, unexpected trip cancellation due to accident, illness, or death. I understand insurance policies can provide coverage for lost baggage, delay of travel, medical expenses and emergency air transit.

I understand that I must purchase Travel Protection Insurance within 10 days of booking for maximum coverage and benefits, including Cancel For Any Reason and for Pre-exisiting Medical Conditions; you can purchase reduced coverage up to 48 hours prior to departure. I also understand that I am able to freely purchase Travel Protection Insurance from any policy provider of my choosing.

*** I understand I am representing all guests listed on my reservation. If selected; I must purchase a policy that covers all travelers I am financially responsible for and whom are listed on the Reservation and Travel Services Contract.

Names of Additional Travelers in group:

Preferred Contact Phone *

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

TRAVEL PROTECTION OPTION, select one: *

ACCEPT: I have selected to PURCHASE Travel Insurance as offered by Cruisy Susie. I have reviewed the Policy Coverage and Terms; I accept that the policy meets my desired protection, plus I understand all insurance premiums are non-refundable.

UNDECIDED: I will review the information provided and understand that the decision is mine to initiate, should I decide to purchase a policy. I understand coverage my have limitations due to delay of purchase based on deposit date.

DECLINE**: I acknowledge that I have received Travel Insurance information and quote; I am WAIVING access to these coverage provisions by DECLINING to purchase the travel insurance offered by Cruisy Susie for my travel plans.

**If UNDECIDED or DECLINING: note that you may purchase limited coverage up to 48 hours prior to travel. Ask your agent for restrictive details. Cruisy Susie will not be held liable for any financial losses incurred from failure to purchase insurance coverage. Insurance Premiums are always non-refundable.

Email for Confirmation & Copy of Submision

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