Thank you for visiting with us! We’re happy to help you. First Name * Last Name * Email * Phone (if you prefer a call) I travel for: Check one: Business Vacation/Pleasure Travel Agent/Tour Operator Volunteer Missions NGO/Relief Worker Social Good Business International Student I would like to know more about: Travel OUTSIDE the USA / Worldwide coverage Travel WITHIN the USA Travel TO the USA Team travel / Travel as a group Adventure sports coverage / Extreme sports Frequent-flyer plans / Annual travel plans Long-term / Expat coverage Affordable health insurance in the USA (Non-ACA) Int’l. Group health insurance with worldwide coverage Anything else we should know? I’d like to know more about >> I’d like to receive the GNI Quarterly e-Newsletter 4X a year with travel tips and savings. Before hitting “SUBMIT” scroll down to see if there is anything else we need to know. Thank you for allowing GOOD NEIGHBOR INSURANCE to help you travel safer and travel smarter! SUBMIT Have a question? Live Chat with us >> P.S. – Please send me the following free guide(s): “The Top Three Risks When Traveling Overseas” Guide Our “Travel Safety 101” Guide Our “Travel Medical Guide” by Dr. John Askew “The Definitive Guide to Jet Lag” How did you hear about us? LA Travel and Adventure Show Other: For a more specific recommendation, please tell us… Date of Birth (enter in MM-DD-YYYY format) Country of Residency? Country of Citizenship? Traveling by yourself? Traveling with one other Traveling with family Traveling with 2-5 people Traveling with 6-20 people Traveling with an organization Approximate age of travelers? Varied ages, incl. children Varied ages, mostly 60+ 0-18 yrs old 19-54 yrs old 55-64 yrs old 65-85+ yrs old Company Name (if applicable) Title Street Address Suite or Attn: City State Postal Code Country Please select oneAfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamas (the)BahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean Territory (the)Brunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman Islands (the)Central African Republic (the)ChadChileChinaChristmas IslandCocos (Keeling) Islands (the)ColombiaComoros (the)Congo (the Democratic Republic of the)Congo (the)Cook Islands (the)Costa RicaCôte d’IvoireCroatiaCubaCuraçaoCyprusCzech Republic (the)DenmarkDjiboutiDominicaDominican Republic (the)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (the) [Malvinas]Faroe Islands (the)FijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern Territories (the)GabonGambia (the)GeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly See (the)HondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea (the Democratic People’s Republic of)Korea (the Republic of)KuwaitKyrgyzstanLao People’s Democratic Republic (the)LatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedonia (the former Yugoslav Republic of)MadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall Islands (the)MartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Midway IslandsMoldova (the Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlands (the)New CaledoniaNew ZealandNicaraguaNiger (the)NigeriaNiueNorfolk IslandNorthern Mariana Islands (the)NorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippines (the)PitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian Federation (the)RwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSouthern RhodesiaSpainSri LankaSudan (the)SurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwan (Province of China)TajikistanTanzania, United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos Islands (the)TuvaluUgandaUkraineUnited Arab Emirates (the)United KingdomUnited StatesUnited States Minor Outlying Islands (the)Upper VoltaUruguayUzbekistanVanuatuVenezuela (Bolivarian Republic of)Viet NamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Company phone # Ext # Do you (or any traveler with you) have a pre-existing medical condition? 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