Group Leader Traveler Application

Traveler Application & Release Form

IMPORTANT: Please fill out the following information and click submit to submit your application online. Please give us your full, legal name as shown on your passport or, for domestic trips, as shown on your driver’s license, government or school issued ID. We must have your full, legal name to purchase your airline ticket. If taking an international trip, be sure to obtain your passport no later than 3-4 months prior to your trip. Passport MUST be valid for at least 6 months after your return date.

Step 1 of 4

Group Leader Traveler Information

Name of traveler (as on Passport) *

First

Middle

Last

As on passport or government issued id.

Date of Birth: M/D/Y (example Sept/4/2005) *

*To eliminate confusion please spell out the month

Gender *

What is your national citizenship? *

Country/citizenship with which your passport is associated.

Passport number *

Required for international hotel stays, activities and flight information/bookings

Passport expiration date: M/D/Y (example Jan/8/2015) *

*To eliminate confusion please spell out the month * Keep in mind many countries require at least 6 months of passport validity upon date of entry into the country.

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone number *

Alternative phone number *

Email *

IMJ Trip destination you are applying for *

Dates of travel *

Example: DD/MM/YYYY - DD/MM/YYYY

Immeasurable Journeys Travel Shirt *

What excites you the most about participating in this trip?

School/Organisation Information

Your School/Organisation *

Your School/Organisation Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

School/Organisation phone number *

School/Organisation Emergency Contact Details

In the unlikely event of trip schedule changes, flight delays/cancellations or emergencies, please tell us how your group would like to be contacted, if the group leader is non-contactable.

Primary Emergency Contact (non-traveler) *

First

Middle

Last

Phone *

Alternate phone number *

Email *

Secondary Emergency Contact (non-traveler) *

First

Middle

Last

If the above person is unable to manage the crisis, this person will succeed in management:

Phone *

Alternate phone number *

Email *

Travel Insurance

Travelex Insurance Services, Student Group Essentials plan is paid and provided by Immeasurable Journeys as part of your trip package.

This plan includes post-departure benefits only. Visit https://policy.travelexinsurance.com/SERZ-0823 and select Colorado from the dropdown menu to view a copy of the policy. For your convenience, we also offer additional coverage options which enhance the already included Group Essential Plan coverage.Additional Option 1: Plus Plan or Option 2: Plus Plan with CFAR upgrade. For more information and rates, refer to the Student Group Plus flyer at www.travelexinsurance.com/docs/studentplus. Travel Insurance is offered on behalf of and under the direction of Travelex Insurance Services.

Additional Option 1: Plus Plan ........ Option 2: Plus Plan with CFAR upgrade *

Yes - Option 1: Plus Plan -  I would like to purchase the offered travel protection plan. I have read and understand the policy, which includes the full coverage term details, including exclusions and limitations, and Travel Protection Plan flyer, which includes important consumer information, plan highlights, and rates. To view/download the policy, visit: https://policy.travelexinsurance.com/SPRZ-0823, and select your state of residence.
Yes - Option 2: Plus Plan with CFAR Upgrade  - I would like to purchase the offered travel protection plan with Cancel For Any  Reason coverage. I meet the purchase requirements for the upgrade, have read and understand the policy, which includes the full coverage term details, including exclusions and limitations, and Travel Protection Plan flyer, which includes important consumer information, plan highlights, and rates. To view/download the policy, visit: https://policy.travelexinsurance.com/SPRZ-0823, and select your state of residence.
Yes - I have purchased through another provider.
No - I wish to decline travel protection at this point in time.

Message

Group Leader Traveler Application

Traveler Application & Release Form

Group Leader Traveler Information

Health Information

School/Organisation Information

School/Organisation Emergency Contact Details

Travel Insurance

Travelex Insurance Services, Student Group Essentials plan is paid and provided by Immeasurable Journeys as part of your trip package.

Journey Policies