Share your information with Heather Kaiman

Heather Kaiman

reNew Travel

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  <body>
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	<fields><field type="text" subtype="text" required="true" label="First name" className="form-control" name="first-name"></field><field type="text" subtype="text" required="true" label="Last name" className="form-control" name="last-name"></field><field type="text" subtype="text" required="true" label="Email" className="form-control" name="email"></field>&#13;
		<field type="paragraph" subtype="p" label="Travel insurance is strongly recommended, but it is not required. This form is required if declining travel protection/travel insurance. reNEW &amp;nbsp;Travel has offered a travel insurance option that can be purchased. If you are deciding against travel insurance, please read this form and complete your name confirming you have declined insurance for you and the other parties traveling on the reservation."/>&#13;
		<field type="text" required="true" label="Full Name:" name="full-name" subtype="text" className="form-control"/>&#13;
		<field type="paragraph" subtype="p" label="I have been offered travel insurance by reNEW Travel and I do not wish to purchase a travel insurance plan. By completing this form, and entering my name below, I understand that I am declining travel protection/travel insurance. It is the sole responsibility of the passengers completing this form to inform all travelers of the contents of this form.&amp;nbsp;"/>&#13;
		<field type="text" required="true" label="Full Names of all Travelers Declining Travel Insurance:" name="full-names-of-all-travelers-declining-travel-insurance" subtype="text" className="form-control"/>&#13;
		<field type="date" required="true" label="Today&#39;s Date:" name="todays-date" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>

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