• Kip— C^tt|?4
« tnAAJ xance cxm m«
lc« ijoux txip ^o/ixxj -j/iee ' '
0 ^< iluii; m< k ni mjim t! i- llii'
lnil lluiij.' ym think uill hnppin
In vim ttln-ii tr.iM'lmi; iivi-pu>,n
llul Hu-' hi< kin |»i\ i .in sii iki
aintiitm uni Mm i .in lurn .in
.inkli- »n .1 mi k amwln r. Tin
In si mn In in.tki sill• Mill II ,'i I
In Ip is In iisi tin .iiitniii.iln iiisiii.mi.
i mi i.it’i Dial i mnis mill tin- lnliin.ilnni.il
SUl*|i'iil Iil' iilih I ..it11 (m i i ■ nli r sis Inini
II Mm mini limn' lli.m this Immi
111'ui.1 in • p.n k.ii.'imu i an l.iki .nlv.in
tapi n| a uuiiiIh i nl Itlp-Safi niMllalni
upturns ami «1* >1 jjn a p.n k.ijp- sinli il
spi rifnalls lu iinit nun m i lls
I tiillniliii i' »lm puli lia'i- I rip Sail
lull |.|U| \“ ill ill Sii** I In ail |||| nl ainl
liuspilali/alnin iiisiii.uni nmi.i;'
inrlnilt il mill llnir nlinlih ranis
i u\i'i.ti.,i "II prmnli s lu;'j.'.U'* ami p* i
smial t'lFrrls * n'*-ta/* in i iiv. ii| d,ini,in.
In hi loss ul am "I 'mu |n t smial
|m |i'II),'IIIU'> 1 'IVl'NIf' < in'* l> 'nil III
raw- 'mi m-iil to rarti tI a iimi i* In ml
.ilili l.iti I ti|t->afi- iliwil.iin i |• kayi-v
alsn liin In |niti lia'i il In Iravi li i> not
i-li^lhlr fm tin Iiil' rnallimal Mmlfiil
I. .a !ii-i ami Vintll) i mis
l in t nii/i I Itasn sn klii ss ailfl ai' i
ul iiisinam ‘ UK. is ih. sann . m
I ML'' prn'lilril In tin Inli i nalinll.il
|i|* Mill' i ..mis
I •• • rn</' I! Il.i,■ ■ a;■■ s ,i||l,,| |M>.
jM(W‘ |ii r'nnal rfffils insurant! rm
ris |ih\su al daiimyi In m loss nl imn
|n rsniial i fli i Is itii11hi/ vnur IraW'Is
* rtlt/i < Til|i i am a ll.ilmii mill
iiiptiun I'a's it|> I., ih. amount
si ll i ll'll Ini I am I ll.ilmn I hal nirs
impn'id Hi' 'All.i l.ii'- I" n lurii
linlll" "I I" II 'tltll" >"111 ll 11 >. .111(1 111"
i "'ll "I iiiih'' 'I iii'ii i"(timidId" in - mm
"i laud ariantrciiii-nl> dii" le injur>.
'll kll("''> "I ili.llll 'Ulli ll il I" Veil "I
i ui"iiilitT "I i"iii iiiiini-dial" fain11>
l P li.tu l' i ' \."i.'lalice in
in,iml.dim with au\ IT ip-S.ifc pai k
at" ll ' aiiiiul I"- pim lia'i d l>\ il'"ll
NOTK lam r.lp' d""' Hid appl> III III"
iilMin d ' imuiln "I dmuii il" mill" I In
• ihinI ia '.T iliiiinnl" i.s Hu- I inl' d Slat"'
laiiupli l" didail' an- fimnd In tin*
di* "i 11 pi mu id runrai’" which will I"
'"III In Mm w 11 ill II fmir W""k' id III" dal"
Mill "lirnll
lli nii nilwr Mil' ""M iat" is liasi d
mi a r"im!iur'"ui"ul 'VSliin kiip all
i. • ip!'1 O
Program underwritten by National Union Fire Insurance Co
of Pittsburgh, Pa Traveler's Assistance Services supplies) by
American International Assistance Services Inc
Term of
Coverage
1 month
2 months
I months
4 months
5 months
6 months
7 months
8 months
9 months
10 months
11 months
12 months
Coverage C
Coverage D
Coverage
A
S14 90
$21 80
$29 55
$34 90
$40 30
$44 55
$53 50
$62 15
$71 95
$80 65
$87 90
$95 35
$18 75
Sx • .mil
Coverage
R
$15 30
$23 75
$29 20
$33 50
$39 15
$45 40
$51 05
$56 20
$60 75
$64 80
$68 30
$71 30
$37 50
(S 1.000 00 fcmit;
$ 1 00 mandatory
L
Nanx- .tst
7(\rsV
Permanent Addrein
_ " State Z>p
T rirphnoe
Destination
Ap^s .»!»;'"•* .or 'H.4 , j->s! without effective t5.i!r\
EHrt » vr t'ljlr, from
Beneficiary Information {tew insurance purpose)
8eneh< ary Name Rriabonvvip
Benefit i.ir, AiMrp-A
City Stair Zip
Be*x* fx .ary T eirphooe
■ t ( ch Guardian if insured h i mmor) Date
yes
Youth v* Teacher identity Card ho*der
Cover Age A . B ♦ C *V Cover Age D (Mandatory S
-ota Payment I noosed S
Return completed Trip Safe application to
CUE Ins Dept 206 East 42nd Street. New York NY 10017
Make certified check or money order payable to ClEE
J