Trip Cost
Age
Passenger #1:
$0 - $500.99
$501 - $1000.99
$1001 - $1500.99
$1501 - $2000.99
$2001 - $2500.99
$2501 - $3000.99
$3001 - $3500.99
$3501 - $4000.99
$4001 - $4500.99
$4501 - $5000.99
$5001 - $5500.99
$5501 - $6000.99
$6001 - $6500.99
$6501 - $7000.99
$7001 - $8000.99
$8001 - $9000.99
$9001 - $10000.99
$10001 - $11000.99
$11001 - $12000.99
$12001 - $13000.99
$13001 - $14000.99
$14001 - $15000
34 & Under
35 - 59
60 - 69
70 - 74
75 - 79
80 - 84
85+
Passenger #2:
Choose Trip Cost
$0 - $500.99
$501 - $1000.99
$1001 - $1500.99
$1501 - $2000.99
$2001 - $2500.99
$2501 - $3000.99
$3001 - $3500.99
$3501 - $4000.99
$4001 - $4500.99
$4501 - $5000.99
$5001 - $5500.99
$5501 - $6000.99
$6001 - $6500.99
$6501 - $7000.99
$7001 - $8000.99
$8001 - $9000.99
$9001 - $10000.99
$10001 - $11000.99
$11001 - $12000.99
$12001 - $13000.99
$13001 - $14000.99
$14001 - $15000
Choose Age
34 & Under
35 - 59
60 - 69
70 - 74
75 - 79
80 - 84
85+
Passenger #3:
Choose Trip Cost
$0 - $500.99
$501 - $1000.99
$1001 - $1500.99
$1501 - $2000.99
$2001 - $2500.99
$2501 - $3000.99
$3001 - $3500.99
$3501 - $4000.99
$4001 - $4500.99
$4501 - $5000.99
$5001 - $5500.99
$5501 - $6000.99
$6001 - $6500.99
$6501 - $7000.99
$7001 - $8000.99
$8001 - $9000.99
$9001 - $10000.99
$10001 - $11000.99
$11001 - $12000.99
$12001 - $13000.99
$13001 - $14000.99
$14001 - $15000
Choose Age
34 & Under
35 - 59
60 - 69
70 - 74
75 - 79
80 - 84
85+
Passenger #4:
Choose Trip Cost
$0 - $500.99
$501 - $1000.99
$1001 - $1500.99
$1501 - $2000.99
$2001 - $2500.99
$2501 - $3000.99
$3001 - $3500.99
$3501 - $4000.99
$4001 - $4500.99
$4501 - $5000.99
$5001 - $5500.99
$5501 - $6000.99
$6001 - $6500.99
$6501 - $7000.99
$7001 - $8000.99
$8001 - $9000.99
$9001 - $10000.99
$10001 - $11000.99
$11001 - $12000.99
$12001 - $13000.99
$13001 - $14000.99
$14001 - $15000
Choose Age
34 & Under
35 - 59
60 - 69
70 - 74
75 - 79
80 - 84
85+
Passenger #5:
Choose Trip Cost
$0 - $500.99
$501 - $1000.99
$1001 - $1500.99
$1501 - $2000.99
$2001 - $2500.99
$2501 - $3000.99
$3001 - $3500.99
$3501 - $4000.99
$4001 - $4500.99
$4501 - $5000.99
$5001 - $5500.99
$5501 - $6000.99
$6001 - $6500.99
$6501 - $7000.99
$7001 - $8000.99
$8001 - $9000.99
$9001 - $10000.99
$10001 - $11000.99
$11001 - $12000.99
$12001 - $13000.99
$13001 - $14000.99
$14001 - $15000
Choose Age
34 & Under
35 - 59
60 - 69
70 - 74
75 - 79
80 - 84
85+
Additional $30,000 of
Emergency Medical Transportation:
(add $15/person + $3 policy fee)
s
Additional Flight Guard Protection:
$100,000
$200,000
$300,000
$400,000
$500,000
(add $9/person
per $100,000 + $3 policy fee)
Collision Damage Waiver:
(add $7/car per day + $3 policy fee)
Cars
1
2
3
4
5
Days:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Trip Length (If Over 30 Days):
(Number from 31-365
add $5/person per day over 30)
($5
policy fee is included)
1. Primary Insured Information:
2. Your Mailing Address:
Street address line 1:
Street address line 2:
City:
State:
--Select a State or Province--
Outside US
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington D.C.
West Virginia
Wisconsin
Wyoming
--Other US--
American Samoa
Federated States Of Micronesia
Guam
Marshall Islands
Northern Mariana Islands
Palau
Puerto Rico
US Virgin Islands
--US Military--
Armed Forces Africa
Armed Forces Americas
Armed Forces Canada
Armed Forces Europe
Armed Forces Middle East
Armed Forces Pacific
--Canadian Provinces--
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Québec
Saskatchewan
Yukon Territory
Zip Code :
Country:
--Select--
United States
Canada
--------
Afghanistan
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
Bosnia and Herzegowina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote D'Ivoire
Croatia (Local Name: Hrvatska)
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and Mc Donald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran (Islamic Republic of)
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Rep. of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia, Former Yugoslav Rep. of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova, Republic of
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and The Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Seychelles
Sierra Leone
Singapore
Slovakia (Slovak Republic)
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and The S.Sandwich Is.
Spain
Sri Lanka
St. Helena
St. Pierre and Miquelon
Sudan
Suriname
Svalbard and Jan Mayen Islands
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Tanzania, United Republic of
Thailand
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Vatican City State (Holy See)
Venezuela
Viet Nam
Virgin Islands (British)
Virgin Islands (U.S.)
Wallis and Futuna Islands
Western Sahara
Yemen
Yugoslavia
Zaire
Zambia
Zimbabwe
Beneficiary - (optional)
First Name:
.
Last Name:
.
3. Details of your safari plans:
Number of People traveling :
Adults
1 adult
2
3
4
5
6
7
8
9
10
over 10
Children [under12 yrs]
0 kids
1
2
3
4
5
6
7
8
9
10
over 10
Number/Type of Rooms:
Double
0 double
1
2
3
4
5
6
7
8
9
10
over 10
Single
0 single
1
2
3
4
5
6
7
8
9
10
over 10
Twin
0 twin
1
2
3
4
5
6
7
8
9
10
over 10
The country I will be traveling from:
--Select country of departure--
United States
Canada
--------
Afghanistan
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
Bosnia and Herzegowina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote D'Ivoire
Croatia (Local Name: Hrvatska)
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and Mc Donald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran (Islamic Republic of)
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Rep. of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia, Former Yugoslav Rep. of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova, Republic of
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and The Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Seychelles
Sierra Leone
Singapore
Slovakia (Slovak Republic)
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and The S.Sandwich Is.
Spain
Sri Lanka
St. Helena
St. Pierre and Miquelon
Sudan
Suriname
Svalbard and Jan Mayen Islands
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Tanzania, United Republic of
Thailand
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Vatican City State (Holy See)
Venezuela
Viet Nam
Virgin Islands (British)
Virgin Islands (U.S.)
Wallis and Futuna Islands
Western Sahara
Yemen
Yugoslavia
Zaire
Zambia
Zimbabwe
Select your Safaris:
Select Your Safari
Hot Air Balloon Safari
Lake Victoria Fishing Safari
Best of Kenya Safari
Classic Kenya
Discover Tanzania
Best Of Tanzania
East African Classic Safari
Discover East Africa
Explore East Africa
Trekking Mount Kilimanjaro
Masai Mara Game Reserve
Amboseli National Park
Loisaba
Lamu
Mombasa
Zanzibar beach
Zanzibar Stone Town
Mnemba Island
Rovos Rail
Blue Train
Sun City
Londolozi
Phinda
Ngala
Cape Town
Johannesburg
Botswana
Nambia
Zimbabwe
Seychelles
or go to Section 6 below and tell us what you'd like.
Airline / Charter:
MANDATORY, PLEASE SELECT
NONE
UNLISTED
CRUISE LINE/PACKAGE AIR
AER LINGUS
AERO MEXICO
AEROFLOT
AIR CANADA
AIR CHINA
AIR FRANCE
AIR INDIA
AIR JAMAICA
AIR LIBERTE/AOM
AIR NEW ZELAND
AIRTRAN AIR
ALASKA AIRLINES
ALITALIA AIRLINES
ALLEGHENY AIRLINES
ALLEGIANT AIR
ALOHA AIRLINES
AMERICA WEST AIRLINES
AMERICAN AIRLINES
ATA (AMERICAN TRANS AIR)
AUSTRIAN AIRLINES
BAHAMASAIR
BRITISH AIRWAYS
CANADIAN AIRLINES INT.
CATHAY PACIFIC
CHINA EASTERN AIRLINE
CHINA SOUTHERN AIRLINE
CONTINENTAL AIRLINES
DELTA AIR LINES
EL AL
FINNAIR
FRONTIER AIRLINES
HAWAIIAN AIRLINES
HORIZON
IBERIA/LINEAS AEREAS DE ESPANA
ICELANDIC AIR
JAPAN AIRLINES
JETBLUE AIRLINES
KLM - ROYAL DUTCH AIRLINES
KOREAN AIR
LANCHILE AIRLINES
LOT POLISH AIRLINES
LUFTHANSA
MEXICANA
MIDATLANTIC AIRWAYS
MIDWAY AIRLINES
MIDWEST EXPRESS
NORTHWEST AIRLINE
PIEDMONT AIRLINES
PRIVATE JET
PSA AIRWAYS
QANTAS
SAS
SINGAPORE AIR
SOUTH AFRICAN AIRWAYS
SOUTHWEST AIRLINES
SPIRIT AIRLINES
SUN COUNTRY AIRLINES
SWISS INTERNATIONAL AIRLINES
THAI AIRWAYS
TURKISH AIRLINES
TWA - TRANS WORLD AIRLINES
UNITED AIRLINES
USAIR
US AIRWAYS
VANGUARD
VIRGIN ATLANTIC AIRWAY
.
Protect Assist and Travel Guard are registered trademarks of ©Travel Guard Group, Inc.,
nsurance Coverage Underwritten by American Assurance Company, a New York insurance company, with its principal place of business at 70 Pine Street, New York, New York 10270. It is currently authorized to transact business in all states and the District of Columbia. NAIC No. 19380.