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Thursday, December 5, 2019
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Travel Insurance
I understand that I may purchase travel insurance to cover certain risks inherent in travel such as supplier bankruptcy and the inability to travel due to a medical or personal emergency. Please check and initial your acceptance or refusal of travel insurance below.
Full Name
*
First
Last
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darrussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russia
Rwanda
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
US Minor Outlying Islands
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Country
Travel Agent Name
*
Select Your Travel Agent. . .
Amanda Miller
Amy Bass
Amy Roberts
Angela Henz
Ashley Dunn
Britney Moran
Cari Fisher
Carla Bandeira
Carla King
Christine Mushal
Cori Barber
David Conklin
David Merrick
David Silipigni
Fatimah Devlin
Gail Gallaway
Ginger Acosta
James King
Jenni Aichele
Jennifer Gallion
Jeremy Gaines
Katey Brown
Katie Batten
Kathy Meserve
Kellye Henckelman
Kim Hickman
Kristy King
Larysa Haley
Lindsey Farley
Lindsey Thibeault
Mary Beth Walls
Mary DeAngelis
Melissa Schulz
Michelle Dunigan
Michelle Sharpe
Michelle Spanos
Miriya Whitaker
Morgan Soto
Myra Supetran
Nicole Larsen
Ramona O'Hearne
Robbie Bulus
Ryan Horne
Sharon Baker
Sharon Johnson
Suzanne Ruthven
Sylvia Massey
Theresa Scherzinger
Therese Diecidue
Torie Jones
Walter Trainum
Wendi Lambright
Choose One
*
I wish to purchase Travel Insurance.
I do not wish to purchase Travel Insurance.
Initials
*
World of Magic Travel (WOMT) acts as a sales agent for any airline, hotel, car-rental company, tour operator, cruise line, or other service provider named in your itinerary (Suppliers). WOMT is not responsible for acts or omissions of the Suppliers, their failure to provide services or adhere to their own schedules, their failure to pay any refund, or for any personal injury, property damage, or other loss, accident, delay, inconvenience, or irregularity which may be caused by any party not under WOMT's control. By accepting, you hereby agree to release WOMT from all claims arising out of any problem covered in this paragraph, to submit all other claims within 30 days after the return of your trip, and to litigate exclusively in the courts in Montgomery County, Texas.
Date
*
Date Format: MM slash DD slash YYYY
Signature
*
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Name
This field is for validation purposes and should be left unchanged.
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