Apply now: traveler plan

1

Your Plan

2

Personal Details

3

medical details

4

payment

Travelers Medical

Select Your age*:

25$

/per day

5$

/per day

15$

/per day

18$

/per day

21$

/per day

28$

/per day

please contact the administrator at info@aim.co.il

* Minimum coverage period is 15 days.

Start Date*:

End Date*:

* Required field .

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Your Plan

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Personal Details

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medical details

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payment

First Name*

Middle Name

Last Name*

Passport*

Social Security/ ID

Birth Date*

Home Address*

City*

State (USA only)

Country*

Zip*

Home Phone*

Mobile

Office Phone

Email*

Address in Israel*

Contact Info in Israel*

Note for Torat Shraga's Students: only Platinum plan possible.

Note for Michlalah's Students: no pay for Gold plan. $120 to upgrade to Platinum plan (before Aug 1st and $175 after Aug 1st)

Note for Shaalavim's Girls Students: no pay for Gold plan. $120 to upgrade to Platinum plan (before Aug 1st and $175 after)

Note for Machon Maayan's Students: only Platinum plan possible.

* Required field

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Your Plan

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Personal Details

3

medical details

4

payment

The applicant has received the following medical care in the last 12 months.

The applicant is presently taking the following medication:

Medication And Dosage

I have read and agree to the Terms & Conditions of the AIM enrollment application. I agree to pay for all other medical and dental services incurred by the above named registrant, which services are not coveredby the terms and conditions of this agreement and by pressing SUBMIT below, request registration for my child on the AIM plan.*

* Required field

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Your Plan

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Personal Details

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medical details

4

payment

Your order:

Travelers Medical coverage,

age

Platinum Plan

Please choose your preferred payment method:

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Travelers Medical

25$

5$

15$

18$

21$

28$

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USA Office

Israel Office