PDF Enrollment Form

To enroll, please fill out the following form:
For one low annual fee you can enroll in UATP Executive Connection. The following is a brief summary of coverage offered with the Executive Connection. Please refer to the Description of Coverage at uatptravelprotection.com for specific terms, conditions and exclusions effective May 1, 2011, or contact us at 1-800-383-0049, 1-215-773-5350 or uatp@aon.com.

I am a(n):

Travel Agent ITATAN ID Cardholder or ITATA ID Cardholder residing in Canada Airline Employee UATP charge card accountholder Other qualified travel industry professional

I would like to enroll in:

Insider's Club Executive Connection

I am:

Sponsored Non-Sponsored

Enrollment Type:

New Re-enroll