GO Travel Protection - Registration Form

	Group Travel Insurance for Group Organizers

User Account Registration Form
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As a subscriber to Leisure Group Travel magazine or InSite newsletter, or as a member of the GO association,
you are pre-qualified to use our travel insurance program designed for busy Group Organizers like you.

All insurance bookings are done using your User Account on the GO Travel Protection website.

Complete this one-page Registration Form to obtain a User ID and Password for your User Account.
We will send you an email containing your User ID and Password.
Please allow 2 business days to process your Registration Form.
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Complete ALL Fields
(all Fields are Required)

User Account Information

First Name:
Last Name :
Company Name :
Agency ID#:	PTM
Address:
City:
State:
Zip:
Daytime Phone #:
Email Address:
Fax #:	(if none, enter "n/a")
Today's Date:
By submitting this Registration Form, I certify that I am a subscriber to Leisure Group Travel Magazine, InSite Newsletter, or a member of the GO association.