We highly reccomend Travel Protection insurance to cover the cost of your vacation and/or penalties due to unforseeable circumstances as injury, illness or death. We provide C.S.A. trip cancellation insurance which is the only insurance available that covers pre-existing medical conditions if purchased at time of deposit of your vacation. The insurance is on ADDITIONAL COST and if accepted the applicable rates will be added to your vacation package cost.

Please Initial: _____ Yes, I accept and wish to purchase Travel Protection insurance.
_____ No, I decline the Travel Protection insurance which has been offered.

Total cost of vacation package (including insurance accepted): $ _______

I authorize CLUB HOLIDAYS ALL INCLUSIVE to charge my Credit Card for the deposit or full payment (please circle one) of the vacation package in the amount of: $ ________

Card holder's signature: _____________

Date: __/__/__

Credit Card type: _Visa _American Express _Master Card
Credit Card number: ___________________ Expiration date: __/__/__
Card holder's name as it appears on Card: _____________
Card holder billing address: ____________________________ City: _________ State: _________ Zip: ______
Home telephone: ________________ Work telephone: ______________

Legal names of ALL persons traveling (first: last). If children are traveling please include date of birth.
A)
B)
C)
D)

Resort selection: ___________________________
Date of departure: __/__/__ Date of return: __/__/__