Self Enrollment

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1. Agreement
2. Find a Plan
3. Choose a Plan
4. Privacy Consent
5. Personal Data
6. Travel Details
7. Payment
8. Confirmation
AgreementI understand that in order to be eligible for this insurance, all of the following statements about myself must be true:
  • During the term of my exchange I will be temporarily engaged in an approved annual or short-term youth exchange through Rotary International.
  • I am a high school student between the ages of 14-19 years (with the exception of Short Term Programs/NGSE up to the age of 30).
  • I understand that medical expense(s) for any condition(s), which existed or were treated within six months prior to my departure for the youth exchange, will be covered only up to $500.
  • I understand coverage will not go into effect until my actual departure or participation in the Rotary Youth Exchange and will terminate immediately upon my return home.
  • I understand that there are no provisions for refunds, upgrades, or downgrades once my exchange begins.
  • I certify that the personal information, which I will provide on the application that follows, will be truthful and accurate.

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(800) 303-8120

Sponsor Code

Please contact your international education program if you do not know your Sponsor's code.

Coverage Start Date

The earliest your coverage can begin is two days from now.

Home District

If you do not know your home country district number, please contact your local District Chairman to obtain that information.

Host District

If you do not know your host country district number, please contact your local District Chairman to obtain that information.

Program Name

If your sponsor has given your trip a program name, please enter it here(optional)

Participant ID

If your sponsor has assigned their own ID to you, please enter it here (this is optional, and is different from the CISI participant ID that will be assigned to you at the conclusion of this enrollment process).

Email Address

Please provide a valid email address to which we can send your confirmation policy materials.

Credit Card Number

Please provide your credit card number. We accept Visa, MasterCard and American Express.

Credit Card Expiration Date

Please indicate the expiration month and year of the credit card in the fields below.

Study Abroad Location

Country to which you will be traveling.

If you are travelling to more than one country, please select "WW - Worldwide" as your location.

Same as contact address

Check this box if your billing address is the same as your previously-entered US mailing address.

Birth Date

Participant must be between the ages of 15-19 years on the exchange start date.

Email Address

When your application and credit card payment are approved, your insurance materials for this policy will be e-mailed as an attachment to your e-mail address. If you do not have your own e-mail account, you may sign up for one through any of the following websites:,,

Home Country

Choose here the country you will be traveling from during your youth exchange.

Host Country

Choose here the country you will be traveling to during your youth exchange.

Beneficiary Name

This plan includes an accidental death benefit. If injuries result in your death within one year after the date of an accident, the death benefit will be paid to the person listed here, or to your estate if the field is left blank.


In this field please indicate the relationship of the named beneficiary to you. For example, mother, father, sister, brother, etc.