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Fill out the registration/credit card authorization form below to register for your trip.

First Name / Middle Name

Passport

Last Name

Passport Expiration Date

Primary Phone

Street Address

City

Postal / Zip code

Region/State/Province

Birthdate *

* If you do not wish to purchase now, the plan can be purchased any time prior to final payment. To view state specific fraud warnings, visit: https://www.travelexinsurance.com/company/fraud-warning. Travelex Insurance Services Inc. (“Travelex Insurance”) maintains an updated list of alerts and financial defaults on its website available at https://www.travelexinsurance.com/customer-service/travel-alerts/travel-supplier. Travelex Insurance Services, Inc. CA Agency License #0D10209. Insurance coverages underwritten by individual member companies of Zurich in North America, including Zurich American Insurance Company (NAIC # 16535).

For more information on available and rates, click here to view the Student Group Deluxe Product Flyer.

For questions regarding benefits or coverages, please contact Travelex Insurance Services at 844-825-1716 and reference plan number SDRZ-0823.

If you would like to purchase the offered travel protection plan, you acknowledge you have read and understand the policy. Click here to view/download the Policy based on your state of residence.

Emergency Contacts First Name

Emergency Contacts Relation

Emergency Contacts Last Name

Emergency Contacts Phone Number

Amount To Be Charged

Card Number

Card Expiration Date

Card Security Code

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(802)540-0055

REGISTER

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LOOKING FOR A TOUR CATALOG?

LOOKING FOR
A TOUR CATALOG?