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Marion Medical Mission Trip 2008
Group Travel Medical Insurance

 

For those volunteers who plan to travel to Africa with the Marion Medical Mission Team 2008:

If you are interested in group travel medical insurance for the trip, please fill out the form below and return it with a check for the amount to cover the number of days you plan to be traveling. Please make the check payable to International Medical Group (IMG) Insurance. We need to receive your information form and check before August 1, 2008 to ensure time to get your insurance information to you before you leave.

Marion Medical Mission
1412 Shawnee Drive
Marion, IL 62959
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 Information for Patriot Group Travel Medical Insurance:

 Name as it appears in your passport:________________________________________________

 Date of birth:_____________________________    Passport Number:_____________________

 Request Effectiveness Date:_________________     Request Expiration Date:_______________

 Number of days of coverage required:_________     *Daily Rate:_________________________

 

*Deductible:___________________

 Amount due:___________________

*Your rate also depend on the deductible:

Deductible                   Rate Factor
$0                                 1.25
$100                             1.10
$250                             1.00
$500                             .90
$1,000                          .80
$2,500                          .70

 

*All members of the group must apply for

the same option number and deductible, so

please let Hanna know as soon as possible

which option you chose.

RateTable08.jpg (77103 bytes)

 

We will go with the majority choice.

The rates listed above are for 2007 and may increase for 2008.

Hanna.hjord@gmail.com

Phone: (618) 997-5365

Fax:      (618) 997-5366

 

More information can be found at IMG’s website:

http://www.imglobal.com/