insurance acknowledgement

This form is the property of Regina Navigium, LLC DBA Cerenity Vacations Travel Company and is not permitted for use by anyone not affiliated with the Company.

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insurance acknowledgement

This form is the property of Regina Navigium, LLC DBA Cerenity Vacations Travel Company and is not permitted for use by anyone not affiliated with the Company.

Name *

Email address *

Phone *

Destination *

Message *

Was Travel Insurance Offered to You? *

Yes
No

Do You Accept or Decline Travel Insurance Coverage? *

Accept
Decline
Self Provided

If Self Provided, Who is your Travel Insurance provider?

If Declined, What is your reason for declining?

Not Needed
Self Provided Coverage
High Price Point
Coverage Options
Other

Do You Need More Information About Travel Insurance Coverage Options? *

Yes
No

Acknowledgement:

I acknowledge that I have reviewed the travel insurance options provided by My Travel Advisor.

I understand the risks involved in traveling without insurance and accept full responsibility for any consequences that may arise from my decision.

Enter Your Name for Signature *

Date Completed *

Send me a copy

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Cerenity Vacations Travel Company is not a Travel Club, and does not offer membership options.

Services are not currently available for residents of, or in the areas of: Florida, California, Hawaii, Washington or Iowa.

Terms & Conditions

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