Share your information with Charity Dunham

Charity Dunham

CD Confidence Travel Co.

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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="header" subtype="h3" label="Travel Insurance Waiver"/>&#13;
		<field type="paragraph" subtype="p" label="Cd Confidence Travel Co. (Advisor) recommends that you purchase travel insurance to protect your investment."/>&#13;
		<field type="paragraph" subtype="p" label="I acknowledge that CD Confidence Travel Co (Advisor) has offered me travel insurance from Allianz Travel Insurance."/>&#13;
		<field type="paragraph" subtype="p" label="I do not wish to purchase insurance protection for my vacation and am declining the travel protection offered from the above provider at this time. By signing this waiver, you acknowledge that you have been offered the opportunity to purchase travel insurance for your upcoming trip. You understand that travel involves certain risks, including but not limited to medical emergencies, trip cancellations, and unforeseen events. You accept full responsibility for any costs or losses incurred due to these risks and agree not to hold CD Confidence Travel Co. named above liable for any damages or expenses arising from your decision to decline travel insurance. It is your responsibility to ensure compliance with all travel requirements and to secure appropriate coverage independently if desired."/>&#13;
		<field type="paragraph" subtype="p" label="By signing below, I understand that declining travel insurance could result in the loss of my travel cost and/or require more money to correct the situation. I also acknowledge that without insurance, there may be no way to recoup any losses, costs or expenses incurred."/>&#13;
		<field type="header" subtype="h1" label="  "/>&#13;
		<field type="radio-group" label="Please choose:" name="please-choose">&#13;
			<option label="I ACCEPT Travel Insurance." value="accept">I ACCEPT Travel Insurance.</option>&#13;
			<option label="I DECLINE Travel Insurance. I understand that this could result in the loss of ALL of my travel costs." value="decline">I DECLINE Travel Insurance. I understand that this could result in the loss of ALL of my travel costs.</option>&#13;
		</field>&#13;
	</fields>&#13;
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