GJN Empowerment Network by Personal Dimensions
Travel Agent Overview
Travel Agent Application
1 FREE QUOTE
Indicates required field
Where would you like to go?
$100 - $500 Per Person
$501 - $1000 Per Person
$!001 - $3000 Per Person
$3001 - $5000 Per Person
$5000+ Per person
How Many Adults
Do ALL travelers have current Passports?
How many Children Under Age 18
Departure Airport or Port of Call
Arrival Airport or Port of Call
Legal Names (Birth dates) of ALL going on the trip:
FOR CRUISES Choose ALL that apply
Pre Pay Gratuities
Ocean View Cabin
Has Client Cruised Before?
Do you have a VIFP Club Member Number?
If Yes, Name of Cruiseline and your VIFP Number
***International Air Travel: Passports are required for all flight travel.
***For Cruises: Verify with cruise line if a passport is required or certified birth certificate is suffice.
Choose ALL that Apply
*By declining Travel Insurance, I understand that I take full responsibility for any occurrences in my travels to include but not limited to
– which provides reimbursement for unused arrangements should you need to interrupt because of unforeseen illness or injury to yourself, a family member, or traveling companion; jury duty; subpoenaed; hijacked; quarantined; direct involvement in a traffic accident; or having your home made uninhabitable by a natural disaster.
- reimburses additional transportation costs and unused vacation days should your vacation be delayed for 12 hrs or more due to, a delay by your airline; lost or stolen travel documents; hijacking; civil commotion, riot; or a traffic accident en route to departure.
- arranges and pre-pays the cost of emergency medical transportation should a serious illness or injury during your vacation require your medical evacuation.
- reimburses medical costs should you incur hospital charges or other medical bills as a result of an illness or injury during your vacation.
Lost/stolen baggage or personal effects
- reimburses you for baggage or items lost, stolen, or damaged during your vacation.
- reimburses for the purchase of necessary personal items if your bags are delayed by the airline for 24 hours or more.
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