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Wherever you go, our worldwide
assistance is by you side

24 hours a day, 7 days a week
.

We at Sunburst International Risk Management are dedicated to being your trusted source for global risk assessment and mitigation consulting and training services. Whether you travel for business, leisure, adventure, or study, the best way to ensure an enjoyable, productive, and safe trip is to be aware of what types of problems you may encounter, take steps to prevent problems before they happen, and be prepared to deal with problems if they do occur. We focus on the things that we believe matter most to our clients - helping them learn how to reduce the uncertainties of international travel and providing them with global protection and peace of mind. We are committed to delivering individualized services, risk assessment expertise, and carefully considered advice to our clients. We are proud to provide superior global protection and peace of mind to international travelers in over 100 countries.


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MEDJET Motocycle Rider Program
Enrollment Application
Agency # DC8023

 

Special Note: Please print and complete this application. Click here for Printer Friendly
                              This application form is valid for Individual and Family Programs only.

Before submitting an application for this plan, be sure to read the Rules & Regulations carefully.

Please make sure your application is legible - Print or Type. Thank you.

Mr. ___  Mrs.___   Ms. ___  Dr. ___    Rev.____

Full Name: _______________________________________________________________

Date of Birth (MM/DD/YY):_____ / _____ / _____

Requested Effective Date (MM/DD/YY): ___________________

Home Address: ______________________________________________________________

City: ___________________________

State: ______________     ZIP: ___________

Phone -Day: (______) _______ - _______

Phone - Evening: (______) _______ - _______

Email Address: _________________________________________________
                          
(We will send confirmation to you via e-mail.)

Is your Mailing Address the same as the one listed above?  __Yes      __No

Please provide your current mailing address if it's different from your Home Address.

_____________________________________________________________________

Family Membership
In addition to yourself, the Family Membership covers your spouse and up to five dependent children under age 19 (or up to age 23 if a full-time student). Please list family members' names and dates of birth.

1. Spouse: __________________________________________   DOB ____________

2. Child: ____________________________________________   DOB ____________

3. Child:_____________________________________________  DOB ____________

4. Child:_____________________________________________  DOB ____________

5. Child:_______________________________________  DOB ____________

Motorcycle Information
VIN Number:______________________              Year:___________
Make:___________________________              Model:__________      Color:__________

Fees of Standard Membership - Please select one option

Standard Program -- under age 75:
7-Day Travel Protection Plan            __Individual $85.00             ___Family $155.00
14-Day Travel Protection Plan          __Individual $105.00           ___Family $195.00
21-Day Travel Protection Plan         __Individual $135.00            ___Family $245.00
One Year
(90 days or less)              __Individual $225.00            ___Family $350.00

Expatriate Program
-- under age 75:
Level One (91-180 days)                 ___Individual $380.00           ___Family $485.00
Level Two (181-270 days)              ___Individual $475.00            ___Family $655.00
Level Three (271-One Year)           ___Individual $595.00             ___Family $885.00

(Certain restrictions apply. These rates available to those under age 75 and 90 day maximum per foreign trip.
For extended-stay, expatriate or Diamond Plan (for individuals 75-85 years of age) membership information,
please call 1-877-211-3654)

Payment Information

Make check payable to MEDJET Assistance

Mail to: Sunburst Worldwide Insurance Services
            P.O. Box 1016, Clovis, CA 93613
            Fax: 559-421-1956
If you pay by Credit Card, you may fax your application.
(Our fax machine is ready to accept your application 24/7.)

Please charge my Credit Card: __ MasterCard   __VISA  __Discover Card   __American Express

Card Number: _________________________________________
Expiration Date ________ / ________

Name - Exactly as it appears on your Credit Card: ________________________________________________

I agree to pay above total amount according renewal card issuer agreement.
I declare that I understand the terms and conditions of MEDJET Assistance Program and that membership fees are non-refundable.

__________________________________________     Application Date: _____________
SIGNATURE
Agency # DC8023

arrow39.gif (959 bytes) Click here for Printer Friendly

arrow39.gif (959 bytes)Click here For Brochure of Motorcycle Rider Program

arrow39.gif (959 bytes) Click here For Rules & Regulations of MEDJET

arrow39.gif (959 bytes) Click here For Aircraft Qualification

arrow39.gif (959 bytes)Click here For Testimonials

 

If you have any questions or concerns, please contact us.
info@internationalriskmanagement.com
877-211-3654 or 559-294-0316

Thank you for visiting our website.
www.InternationalRiskManagement.com
 

 

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HERE'S THE FINE PRINT:

Availability, features, benefits and rates for all plans described on this site are subject to change without notice
at the discretion of the insurance carriers. This site is updated weekly, but we recommend contacting us
directly to be assured of getting the most up-to-date information available.

Copyright © 1999-2008 by Sunburst Worldwide Insurance Services. CA Insurance License #0B65721
Warning: All of the pages on this site are protected under U.S. and International copyright laws.
Reproduction by any means or for any purpose, except as specified on certain pages,

is not allowed without the express written permission of the copyright owner.

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  INTERNATIONAL SECURITY NEWS BRIEFS:
Please note that we at Sunburst International Risk Management provides the International Security News Briefs as a value-added service to our international clients and visitors of this website. Our International Security News Briefs are updated frequently, in order to provide you with current and reliable news and events as quickly as we can. We have no control over the content of external websites, and links to various external news sources may become inactive at any time. We suggest that you bookmark our website and return frequently to check the current global news posted on our website.

Europe - United Kingdom
Crime 'stable' but robbery rises
 July 19, 2007
Crime in England and Wales has remained stable during the past year, according to Home Office figures.

East Asia / Pacific - China
Fifth of China goods sub-standard  July 4, 2007
Nearly a fifth of goods made and sold in China have been found to be sub-standard, Beijing has revealed. The worst problems were found in canned fruit, dried fish and fruit drinks, a food inspectors' report said.

Sub-Saharan Africa - Nigeria
Scots oil worker held in Nigeria  April 1, 2007
A British oil worker is still missing after being kidnapped in Nigeria, the Foreign Office has said.

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for Global Travel Medical, Accident, & Life Insurance

Middle East / N. Africa - Israel  
Israeli union gripped by general strikes Mar. 21, /2007
I
rael's main trade union has launched an open-ended general strike which threatens to bring transport and public services across the country to a halt. 

Europe - Russia
55 Cities Could Face Spring Floods Mar. 15, /2007
More than 55 cities and towns across the country could be flooded this spring, according to a forecast released by the Emergency Situations Ministry.


Middle East / N. Africa - Algeria
Threat to Commercial Aircraft in Algeria
Mar. 14, /2007
There is information that extremists may be planning to conduct an attack against a commercial aircraft carrying Western workers in Algeria. At this time, there is no additional information available as to the specific carrier or the timing of this attack.

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for Global Travel Medical, Accident, & Life Insurance


East Asia / Pacific - Thailand
Army doubts Bangkok attacks likely 
Mar. 12, 2007
Council for National Security chairman Gen Sonthi Boonyaratkalin Sunday dismissed rumours that southern insurgents plan to launch disturbances in the Thai capital anytime from Tuesday through Thursday.


Sub-Saharan Africa - Kenya
Mombasa Athletic Event Threats Mar. 6, 2007
Recent information emanating from alleged extremist elements suggests the World Cross-Country Championship may be the target of an unspecified terrorist attack. The embassy is also aware of public statements by leaders of Kenya’s Coastal Muslim community threatening to disrupt the Championship if the Government of Kenya does not satisfy various demands


Sub-Saharan Africa - Ethiopia  
Tourists 'kidnapped' in Ethiopia  Mar. 2, 2007
Addis Ababa,
Ethiopia: A group of 15 foreign tourists has been kidnapped in north-east Ethiopia. They include 11 French nationals, at least one Briton and an Italian.

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for Global Travel Medical, Accident, & Life Insurance


East Asia / Pacific - Thailand
Muslim insurgency stokes fear in southern Thailand Feb. 26, 2007
PATTANI, Thailand: Some are already calling it war, a brutal Muslim separatist insurgency in southern Thailand that has taken as many as 2,000 lives in three years, with almost- daily bombings, drive-by shootings, arson and beheadings.
 

American Tourist kills mugger with bare hands Feb. 24, 2007
SAN JOSE, Costa Rica - An American tourist who watched as a U.S. military veteran in his 70s used his bare hands to kill an armed assailant in Costa Rica said she thought the attempted robbery was a joke — until the masked attacker held a gun to her head.

Sub-Saharan Africa - Nigeria  
Three Croatians kidnapped in Nigeria
Feb. 19, 2007
Port Harcourt,
Nigeria: Gunmen kidnapped three Croatian oil workers from a bar in Nigeria's oil city of Port Harcourt. 

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for Global Travel Medical, Accident, & Life Insurance


East Asia / Pacific - China
Buddhist beheaded in Thai south
Feb. 9, 2007
A 72-year-old Buddhist rice miller was beheaded in Thailand's rebellious Muslim south on Thursday in an apparent retaliation for a bomb attack on a village tea shop owned by Muslims, police said.

Europe - Russia Feb. 5, 2007
Registration Rules Stir Up Confusion
Moscow, Russia: According to a new law that came into effect Jan. 15, foreigners are now required to hand over their registration papers to migration officials -- via their employer or other sponsor -- every time they leave the country and re-register upon subsequent entry into the country.

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for Global Travel Medical, Accident, & Life Insurance

Sub-Saharan Africa - Nigeria
Captors release nine Chinese oil workers in Nigeria Feb. 5, 2007
Nigeria, Lagos: Hostage takers in Nigeria released nine Chinese oil-worker captives, officials said on Sunday, amid rising violence in Africa's biggest petroleum producer.

Sub-Saharan Africa - Nigeria
Force no solution for Nigeria's oil delta Feb. 2, 2007
The Nigerian government faces a new challenge from spiralling crime in the oil-producing Niger Delta, but wants to avoid turning Africa's oil heartland into a battleground, Energy Minister Edmund Daukorua said.

Sub-Saharan Africa - Nigeria
Demands made for release of hostages 2/1/07
Manila - Nigerian kidnappers holding 24 Filipinos hostage have made "political demands" that have hampered negotiations to free them, the Philippine foreign department said Thursday.

East Asia / Pacific - Thailand 1/30/07
Two explosions in northern Bangkok
Bangkok - Two explosions occurred early on Tuesday morning along the main road in northern Bangkok. There were no casualties reported in the blasts near the Daily News newspaper and Rama Gardens Hotel Bangkok.

Google
 
 

arrow.gif (61 bytes) For Information on How to Protect Yourself, Your Family, Your Employees, and Your Trips Abroad,
Contact our experienced Risk Managers today.

info@internationalriskmanagement.com
877-211-3654
or 559-294-0316

arrow39.gif (1039 bytes) Click here for Instant Quotes & Online Purchase
for Global Travel Medical, Accident, & Life Insurance


arrow39.gif (1039 bytes)International Insurance Plans | Disability Insurance Plans | Online Quotes | Custom Quotes
Companies We Keep | Who Are We?| Contact Us | Home Page | Site Map | Privacy Pledge
Global Safety & Security News Briefs | What's New?
arrow39.gif (1039 bytes)Complimentary Safe Passages for Smart TravelersSM

Copyright (c) 2002-2007 by Sunburst International Risk Management.
Warning: All of the pages on this site are protected under U.S. and International copyright laws.
Reproduction by any means or for any purpose, except as specified on certain pages,

is not allowed without the express written permission of the copyright owner.