Footloose Adventure Europe

INSURANCE: Travel Protection Plan
Premiums per person (includes Insurance Premium Tax at 17.5%)

Duration (days)	UK	Europe	Worldwide
1 – 5	£16	£21	£32
6 – 10	£21	£27	£49
11 – 17	£25	£31	£59
18 – 24	£28	£33	£64
25 – 31	£33	£37	£75
extra week	£9	£114	£23

Children 2–16 years	50% if with insured adult
Infant 0–2 years	Free if with insured parent
Family	Double + £3 per child
66 -69 years	x 150% not area 3
70 - 75 years	x 200% not Area 3
Dangerous activities (see below)	Category A x 125% Category B x 150% Category C x 200%
Skiing	Double – see separate policy

Europe is west of Urals and/or bordering Mediterranean.
Worldwide includes North America

Dangerous activities include but are not limited to: racing, motor rallies, mountaineering, high trekking, air sports, potholing, underwater activities. Please check if in doubt.

ANNUAL MULTI-TRIP POLICY
Adult £155 Family £210
No single trip of more than 31 days. Winter sports 21 days.

This policy also insures your payment against operator failure.

APPLICATION FORM

Names	Under 16	Over 65	Age	Premium
1.
2.
3.
4.
Total Premium (Cheques payable to Footloose Travel Trust)

Address [in BLOCK CAPITALS] of lead name:

Telephone
Period of insurance in days
Date of departure
Zone	UK Europe Worldwide
Special cover
Family

	It is acknowledged and agreed that:
1.	the trip or journey for which insurance is effected is not booked or commenced by any insured person: (a) contrary to medical advice (b) to obtain medical treatment (c) after a terminal prognosis has been made (d) who is receiving or awaiting in-patient treatment.
2.	no insured person is aware of any reason why travel may be cancelled or curtailed.
3.	no insured person is more than 65 years old unless the extra premium has been paid.

Signed
Date

Please print out this form, fill out your details and post together with your cheque to Footloose.

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