{"id":12252,"date":"2026-04-02T13:09:42","date_gmt":"2026-04-02T18:09:42","guid":{"rendered":"https:\/\/travelguardian.ca\/?page_id=12252"},"modified":"2026-04-10T14:05:36","modified_gmt":"2026-04-10T19:05:36","slug":"health-and-dental-quote","status":"publish","type":"page","link":"https:\/\/travelguardian.ca\/en\/health-and-dental-quote\/","title":{"rendered":"Get a Health and Dental Quote"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; custom_padding_last_edited=&#8221;on|tablet&#8221; disabled_on=&#8221;on|on|on&#8221; admin_label=&#8221;Hero Area&#8221; module_id=&#8221;home&#8221; module_class=&#8221;section-id&#8221; _builder_version=&#8221;4.27.5&#8243; _module_preset=&#8221;default&#8221; use_background_color_gradient=&#8221;on&#8221; background_color_gradient_direction=&#8221;178deg&#8221; background_color_gradient_stops=&#8221;rgba(13,14,29,0.65) 52%|gcid-primary-color 100%&#8221; background_color_gradient_overlays_image=&#8221;on&#8221; 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target='gform_ajax_frame_11' id='gform_11'  action='\/en\/wp-json\/wp\/v2\/pages\/12252#gf_11' data-formid='11' novalidate>\n        <div id='gf_progressbar_wrapper_11' class='gf_progressbar_wrapper' data-start-at-zero='1'>\n        \t<p class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>3<\/span><span class='gf_step_page_name'> - Primary Information<\/span>\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_custom' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_custom percentbar_0' style='width:0%; color:; background-color:#adc967;'><span>0%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_11_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><div id='gform_fields_11' class='gform_fields top_label form_sublabel_above description_below validation_below'><div id=\"field_11_15\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><h3 class=\"gsection_title\">Next Steps: Sync an Email Add-On<\/h3><div class='gsection_description' id='gfield_description_11_15'>To get the most out of your form, we suggest that you sync this form with an email add-on. To learn more about your email add-on options, visit the following page (https:\/\/www.gravityforms.com\/the-8-best-email-plugins-for-wordpress-in-2020\/). Important: Delete this tip before you publish the form.<\/div><\/div><div id=\"field_11_7\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Get a Health and Dental Quote<\/h3><div class='gsection_description' id='gfield_description_11_7'>Please fill out all of the required information, and one of our specialists will be in contact with you within 24 hours. Thank you for choosing Travel Guardian!<\/div><\/div><div id=\"field_11_61\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Primary Person<\/h3><\/div><fieldset id=\"field_11_1\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-half gfield_contains_required field_sublabel_hidden_label gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Full Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_11_1'>\n                            \n                            <span id='input_11_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.3' id='input_11_1_3' value=''   aria-required='true'   placeholder='First Name'  \/>\n                                                    <label for='input_11_1_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>First Name<\/label>\n                                                <\/span>\n                            \n                            <span id='input_11_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.6' id='input_11_1_6' value=''   aria-required='true'   placeholder='Last Name'  \/>\n                                                    <label for='input_11_1_6' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Last Name<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_11_2\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half gfield_contains_required field_sublabel_hidden_label gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Email Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_11_2_container'>\n                                <span id='input_11_2_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_2' id='input_11_2' value=''   placeholder='Your Email Address' aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_11_2' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Email Address<\/label>\n                                <\/span>\n                                <span id='input_11_2_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_2_2' id='input_11_2_2' value=''   placeholder='Confirm Your Email Address' aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_11_2_2' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Confirm Email Address<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/fieldset><div id=\"field_11_5\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_5'>Phone Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_5' id='input_11_5' type='tel' value='' class='medium'  placeholder='(XXX) XXX XXXX' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_11_77\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_77'>Province of Residence<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_77' id='input_11_77' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Alberta' >Alberta<\/option><option value='British Columbia' >British Columbia<\/option><option value='Manitoba' >Manitoba<\/option><option value='New Brunswick' >New Brunswick<\/option><option value='Newfoundland and Labrador' >Newfoundland and Labrador<\/option><option value='Nova Scotia' >Nova Scotia<\/option><option value='Ontario' >Ontario<\/option><option value='Prince Edward Island' >Prince Edward Island<\/option><option value='Quebec' >Quebec<\/option><option value='Saskatchewan' >Saskatchewan<\/option><option value='Northwest Territories' >Northwest Territories<\/option><option value='Nunavut' >Nunavut<\/option><option value='Yukon' >Yukon<\/option><\/select><\/div><\/div><div id=\"field_11_21\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half gfield_contains_required field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_21'>Date of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_21' id='input_11_21' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_11_21_date_format gfield_description_11_21\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_11_21_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_11_21' class='gform_hidden' value='https:\/\/travelguardian.ca\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><div class='gfield_description' id='gfield_description_11_21'>Please note that eligibility is limited to individuals aged below 80 years.<\/div><\/div><fieldset id=\"field_11_91\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Gender<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_11_91'>\n\t\t\t<div class='gchoice gchoice_11_91_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_91' type='radio' value='Female'  id='choice_11_91_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_11_91_0' id='label_11_91_0' class='gform-field-label gform-field-label--type-inline'>Female<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_91_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_91' type='radio' value='Male'  id='choice_11_91_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_11_91_1' id='label_11_91_1' class='gform-field-label gform-field-label--type-inline'>Male<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_91_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_91' type='radio' value='Other'  id='choice_11_91_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_11_91_2' id='label_11_91_2' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_11_63\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Consent to Contact and Use of Information<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_11_63'><div class='gchoice gchoice_11_63_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_63.1' type='checkbox'  value='By checking this box, you consent to Travel Guardian Insurance Ltd. and its insurance partners collecting, using, and sharing your personal information to contact you (by phone, email, or text) and to provide, manage, or renew your insurance quote or policy.'  id='choice_11_63_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_63_1' id='label_11_63_1' class='gform-field-label gform-field-label--type-inline'>By checking this box, you consent to Travel Guardian Insurance Ltd. and its insurance partners collecting, using, and sharing your personal information to contact you (by phone, email, or text) and to provide, manage, or renew your insurance quote or policy.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_11_86\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >You may <a href=\"https:\/\/travelguardian.ca\/en\/unsubscribe\/\" style=\"color:#2c7be5; font-weight:bold;\">\n    withdraw your consent\n<\/a> or update your communication preferences at any time. For details, see our <a href=\"https:\/\/travelguardian.ca\/en\/privacy-policy\/\" style=\"color:#2c7be5; font-weight:bold;\">\n    privacy policy\n<\/a>. If you do not consent, we\u2019re unable to complete your quote online \u2014 please call our licensed agents for assistance.\n<\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_11_62' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_11_2' class='gform_page' data-js='page-field-id-62' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_11_2' class='gform_fields top_label form_sublabel_above description_below validation_below'><div id=\"field_11_64\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Get a Health and Dental Quote<\/h3><div class='gsection_description' id='gfield_description_11_64'>Please fill out all of the required information, and one of our specialists will be in contact with you within 24 hours. Thank you for choosing Travel Guardian!<\/div><\/div><div id=\"field_11_55\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Family Information<\/h3><\/div><fieldset id=\"field_11_73\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Single or Family Coverage?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_11_73'>\n\t\t\t<div class='gchoice gchoice_11_73_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_73' type='radio' value='Single'  id='choice_11_73_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_11_73_0' id='label_11_73_0' class='gform-field-label gform-field-label--type-inline'>Single<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_73_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_73' type='radio' value='Couple'  id='choice_11_73_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_11_73_1' id='label_11_73_1' class='gform-field-label gform-field-label--type-inline'>Couple<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_73_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_73' type='radio' value='Family'  id='choice_11_73_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_11_73_2' id='label_11_73_2' class='gform-field-label gform-field-label--type-inline'>Family<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_11_17\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_17'>Number of Individuals (including primary person)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_17' id='input_11_17' class='medium gfield_select'  aria-describedby=\"gfield_description_11_17\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><\/select><\/div><div class='gfield_description' id='gfield_description_11_17'>Details for the primary person have already been recorded. For couples, this number should equal 2. For a family of 3 (i.e. couple and one child), this number should be 3, and so on.<\/div><\/div><div id=\"field_11_82\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >Your details are already recorded. If you need to make changes, please go back to Step 1.<\/div><div id=\"field_11_87\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >Your details are already recorded. If you need to update them, please return to Step 1. <strong> To add information for additional family members, simply change the number of individuals and the necessary fields will appear. <\/strong><\/div><fieldset id=\"field_11_26\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-half gfield_contains_required field_sublabel_hidden_label gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >1st Additional Family Member<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_11_26'>\n                            \n                            <span id='input_11_26_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_26.3' id='input_11_26_3' value=''   aria-required='true'   placeholder='First Name'  \/>\n                                                    <label for='input_11_26_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_11_26_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_26.6' id='input_11_26_6' value=''   aria-required='true'   placeholder='Last Name'  \/>\n                                                    <label for='input_11_26_6' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_11_97\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_97'>Date of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_97' id='input_11_97' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_11_97_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_11_97_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_11_97' class='gform_hidden' value='https:\/\/travelguardian.ca\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><fieldset id=\"field_11_23\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-half gfield_contains_required field_sublabel_hidden_label gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >2nd Additional Family Member<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_11_23'>\n                            \n                            <span id='input_11_23_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_23.3' id='input_11_23_3' value=''   aria-required='true'   placeholder='First Name'  \/>\n                                                    <label for='input_11_23_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_11_23_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_23.6' id='input_11_23_6' value=''   aria-required='true'   placeholder='Last Name'  \/>\n                                                    <label for='input_11_23_6' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_11_98\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_98'>Date of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_98' id='input_11_98' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_11_98_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_11_98_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_11_98' class='gform_hidden' value='https:\/\/travelguardian.ca\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><fieldset id=\"field_11_29\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-half gfield_contains_required field_sublabel_hidden_label gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >3rd Additional Family Member<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_11_29'>\n                            \n                            <span id='input_11_29_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_29.3' id='input_11_29_3' value=''   aria-required='true'   placeholder='First Name'  \/>\n                                                    <label for='input_11_29_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_11_29_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_29.6' id='input_11_29_6' value=''   aria-required='true'   placeholder='Last Name'  \/>\n                                                    <label for='input_11_29_6' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_11_99\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_99'>Date of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_99' id='input_11_99' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_11_99_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_11_99_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_11_99' class='gform_hidden' value='https:\/\/travelguardian.ca\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><fieldset id=\"field_11_35\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-half gfield_contains_required field_sublabel_hidden_label gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >4th Additional Family Member<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_11_35'>\n                            \n                            <span id='input_11_35_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_35.3' id='input_11_35_3' value=''   aria-required='true'   placeholder='First Name'  \/>\n                                                    <label for='input_11_35_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_11_35_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_35.6' id='input_11_35_6' value=''   aria-required='true'   placeholder='Last Name'  \/>\n                                                    <label for='input_11_35_6' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_11_100\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_100'>Date of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_100' id='input_11_100' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_11_100_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_11_100_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_11_100' class='gform_hidden' value='https:\/\/travelguardian.ca\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><fieldset id=\"field_11_32\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-half gfield_contains_required field_sublabel_hidden_label gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >5th Additional Family Member<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_11_32'>\n                            \n                            <span id='input_11_32_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_32.3' id='input_11_32_3' value=''   aria-required='true'   placeholder='First Name'  \/>\n                                                    <label for='input_11_32_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_11_32_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_32.6' id='input_11_32_6' value=''   aria-required='true'   placeholder='Last Name'  \/>\n                                                    <label for='input_11_32_6' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_11_101\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_101'>Date of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_101' id='input_11_101' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_11_101_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_11_101_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_11_101' class='gform_hidden' value='https:\/\/travelguardian.ca\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_11_74' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_11_74' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_11_3' class='gform_page' data-js='page-field-id-74' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_11_3' class='gform_fields top_label form_sublabel_above description_below validation_below'><div id=\"field_11_75\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Get a Health and Dental Quote<\/h3><div class='gsection_description' id='gfield_description_11_75'>Please fill out all of the required information, and one of our specialists will be in contact with you within 24 hours. Thank you for choosing Travel Guardian!<\/div><\/div><div id=\"field_11_54\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Additional Questions<\/h3><\/div><fieldset id=\"field_11_104\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Which benefits are you most interested in?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_11_104'><div class='gchoice gchoice_11_104_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_104.1' type='checkbox'  value='Health'  id='choice_11_104_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_104_1' id='label_11_104_1' class='gform-field-label gform-field-label--type-inline'>Health<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_11_104_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_104.2' type='checkbox'  value='Drugs'  id='choice_11_104_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_104_2' id='label_11_104_2' class='gform-field-label gform-field-label--type-inline'>Drugs<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_11_104_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_104.3' type='checkbox'  value='Dental'  id='choice_11_104_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_104_3' id='label_11_104_3' class='gform-field-label gform-field-label--type-inline'>Dental<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_11_80\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do you have group coverage that is about to expire?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_11_80'>\n\t\t\t<div class='gchoice gchoice_11_80_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_80' type='radio' value='Yes'  id='choice_11_80_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_11_80_0' id='label_11_80_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_80_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_80' type='radio' value='No'  id='choice_11_80_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_11_80_1' id='label_11_80_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_11_50\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_50'>When will your existing coverage expire?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_50' id='input_11_50' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_11_106\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do you have any current prescription medication that you require coverage for?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_11_106'>\n\t\t\t<div class='gchoice gchoice_11_106_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_106' type='radio' value='Yes'  id='choice_11_106_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_11_106_0' id='label_11_106_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_106_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_106' type='radio' value='No'  id='choice_11_106_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_11_106_1' id='label_11_106_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_11_102\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_102'>Please list medications below<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_102' id='input_11_102' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_11_103\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Preferred contact method<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_11_103'><div class='gchoice gchoice_11_103_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_103.1' type='checkbox'  value='Phone'  id='choice_11_103_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_103_1' id='label_11_103_1' class='gform-field-label gform-field-label--type-inline'>Phone<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_11_103_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_103.2' type='checkbox'  value='Email'  id='choice_11_103_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_103_2' id='label_11_103_2' class='gform-field-label gform-field-label--type-inline'>Email<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_11_88\" class=\"gfield gfield--type-captcha gfield--input-type-captcha gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_88'>CAPTCHA<\/label><div id='input_11_88' class='ginput_container ginput_recaptcha' data-sitekey='6Lfte1QrAAAAAEkbs9LoCBbpm7iSwhhk41sTq7zg'  data-theme='light' data-tabindex='0'  data-badge=''><\/div><\/div><\/div><\/div>\n        <div class='gform-page-footer gform_page_footer top_label'><input type='submit' id='gform_previous_button_11' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='submit' id='gform_submit_button_11' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Submit'  \/> <input type='hidden' name='gform_ajax' value='form_id=11&amp;title=&amp;description=&amp;tabindex=0&amp;theme=orbital&amp;styles=[]&amp;hash=1e8bbdd1965c52050a4fe6712a20266c' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_11' value='iframe' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_11' id='gform_theme_11' value='orbital' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_11' id='gform_style_settings_11' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_11' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='11' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='CAD' value='Sd40C8eMbw6dTewPMAQd7MaY5+j7sLNmU3m0z7J4GD6V\/jhb2cn+zXLxBuniGxLsaD3+RcrU9b\/8Bb7PsN7vjMVq3zRdC3vxdjktRKhWlQBJht8=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_11' value='WyJ7XCI3N1wiOltcImQ3YjMyODAzMzBmMGNiNWI3NTE3ZTQxNTIyNGRhZmJkXCIsXCIwZWQwMWU2MGMxMjcxZDEwYWI1ZTNlYzUyMzllNmU3MVwiLFwiMWNjOGRlZWJjYjU2MWVkNzA2Yjc0ZjY0MTk5OTRkYzhcIixcImI5YzAwYzRhNjMyOWRjMTliNWQ5YjgxZWNmZTEzYTU2XCIsXCJkOWUzNTdlZjgyNTA2ZDRiM2MwY2U5NzU5YjRmNTI4M1wiLFwiMWRjMmQ5OTY2OGRlYjUzMTVlNjZjNTY3ODZkM2YwZjBcIixcIjhhNTJhNWM3ZTFkYjU4NmQ1M2Q1M2MzYzYyZWUyNWMyXCIsXCI0ZWEzODNmYWM1ODcyOTUzZDBjZjFkOGFhNzYzNzgzNlwiLFwiMzc4MWY5NDY3MDYyZDJlYjc2NmNiOWI0NDdhNTlmZTRcIixcImMwMmNkY2RiNTI4MjY3MTZlNjgzNTIxZDhmZjY4MmE2XCIsXCJiZGVjZDc4N2Q4Y2UxMWExYzlmMTQ2ODVkMTA3NjY1NVwiLFwiMDg2NmU0ZWYxMzE4NmY5ZmIzMTU1NGEyMmFkMDllNmJcIixcIjA5MmZiYjA4MzkyOTFlM2FhZjllZDFlYjg5MjBhYTNmXCJdLFwiOTFcIjpbXCI5YWMxODk2ZGRlZWU3ZWYwODE1ZmIzYjIyNTcwNWIyYVwiLFwiZjU1MjgwYjZjMjYxMTAyYjYzMjEyNDZkYzU5NDAzYTVcIixcIjYxZmEzNzJiNTMzOWYzZWNlMGQ5NDZkYjY1ZDAxZTc2XCJdLFwiNjMuMVwiOlwiMmI0ODQ1YmU4NzJhZTQ3ZWJiZDM1NjIyMGFkY2JjYzJcIixcIjczXCI6W1wiZjMzYmU5N2FmZWM3MGYwNmNiZWQwZGQzZmVjYWM1NjRcIixcIjVkOTFmNGQ1NjIyNGExYjVmZTJjNjE2YzdkMjYyOTc4XCIsXCJjNmU4ZTc0MGI2M2U1MjRkNTgzOTEwNjMyOGY4MmVhMFwiXSxcIjE3XCI6W1wiYTUxYWViMmI1NzU3ZWVlNjU0OTE0YWM2MjYzODI3NTZcIixcIjAyNTFjMTc3NTgxYThiYWE0YjRlZTM3ZTM4ZWNhYjk1XCIsXCI0MDEzNGM0ZGIzM2NhZDFhNmZmNWIxMGE2MWQwMzdjZlwiLFwiOGRiODk5MTc2NmYwM2Q1YmMxYWQ4N2NlZDQ1NTY5Y2VcIixcIjc5YmY5MTFlNGQyZjI1NmE3NjFjYTUyODA2YWQ4NzQxXCIsXCIwZDM1N2JiN2FmODI5ZDI5MGI1M2FmYWQwZWMwYTc3NlwiXSxcIjEwNC4xXCI6XCJhN2Q0ZWIwOGE2YjhjYzFhZDdiOTVjZjdjMjg3ZmEyNFwiLFwiMTA0LjJcIjpcImIxNTJiYzdmYTliZTcxMGQ2MjM3M2FmM2MyY2FkMjZmXCIsXCIxMDQuM1wiOlwiM2YyODdhNDg1MWNjYzNiZDZmZTlmZWQwMWUxODY4YjVcIixcIjgwXCI6W1wiNWZjOGYxYjI3MzQ1MjdhYTVhZWUwM2VmOTE3N2MxZmVcIixcIjNlN2EzZTdkNzk3MGRjYmFmOGM2NWU0YjNiNzA4NWI3XCJdLFwiMTA2XCI6W1wiNWZjOGYxYjI3MzQ1MjdhYTVhZWUwM2VmOTE3N2MxZmVcIixcIjNlN2EzZTdkNzk3MGRjYmFmOGM2NWU0YjNiNzA4NWI3XCJdLFwiMTAzLjFcIjpcImI2ODA5N2JmZWQ2MGMzOWYyOGQwNWEwZjM4YjEyMzIyXCIsXCIxMDMuMlwiOlwiZjBlNGZkMjA3NzU2OTFiZTRkZjhlODY5MmFjY2QzMjFcIn0iLCJhNTJiMjVmNDMyZmViNTkwYmEzMGM1NGVhZjM0YjkxYyJd' 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Simple&#8221; content_max_width=&#8221;100%&#8221; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; header_level=&#8221;h2&#8243; header_font=&#8221;Red Hat Display|700|||||||&#8221; header_text_color=&#8221;#0d0e1d&#8221; header_font_size=&#8221;48px&#8221; header_line_height=&#8221;120%&#8221; body_font=&#8221;Lato||||||||&#8221; body_text_color=&#8221;#555555&#8243; body_font_size=&#8221;18px&#8221; body_line_height=&#8221;160%&#8221; custom_margin=&#8221;||42px||false|false&#8221; header_font_size_tablet=&#8221;40px&#8221; header_font_size_phone=&#8221;32px&#8221; header_font_size_last_edited=&#8221;on|phone&#8221; custom_css_blurb_title=&#8221;padding-bottom:32px&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p>Travel insurance is an essential investment that provides peace of mind while you&#8217;re exploring the world. Whether you&#8217;re traveling for business, leisure, or a special occasion, having the right coverage can protect you against unexpected events such as medical emergencies, trip cancellations, or lost luggage.\u00a0<\/p>\n<p>Getting a travel insurance quote with us is quick and simple. By providing a few key details about your trip, you can receive a range of options tailored to your unique requirements. 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Based on this information, a licenced travel insurance agent will find a customized quote for you.<\/p>\n<p>[\/et_pb_accordion_item][et_pb_accordion_item title=&#8221;Is travel insurance mandatory?&#8221; toggle_icon=&#8221;&#x4c;||divi||400&#8243; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;RGBA(255,255,255,0)&#8221; background_enable_color=&#8221;on&#8221; border_width_all=&#8221;0px&#8221; border_width_bottom=&#8221;1px&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p>While travel insurance is not legally required in most cases, it is highly recommended to protect yourself from unexpected events that could disrupt your trip. 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Sync an Email Add-On<\/h3><div class='gsection_description' id='gfield_description_11_15'>To get the most out of your form, we suggest that you sync this form with an email add-on. To learn more about your email add-on options, visit the following page (https:\/\/www.gravityforms.com\/the-8-best-email-plugins-for-wordpress-in-2020\/). Important: Delete this tip before you publish the form.<\/div><\/div><div id=\"field_11_7\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Get a Health and Dental Quote<\/h3><div class='gsection_description' id='gfield_description_11_7'>Please fill out all of the required information, and one of our specialists will be in contact with you within 24 hours. Thank you for choosing Travel Guardian!<\/div><\/div><div id=\"field_11_61\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Primary Person<\/h3><\/div><fieldset id=\"field_11_1\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-half gfield_contains_required field_sublabel_hidden_label gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Full Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_11_1'>\n                            \n                            <span id='input_11_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.3' id='input_11_1_3' value=''   aria-required='true'   placeholder='First Name'  \/>\n                                                    <label for='input_11_1_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>First Name<\/label>\n                                                <\/span>\n                            \n                            <span id='input_11_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.6' id='input_11_1_6' value=''   aria-required='true'   placeholder='Last Name'  \/>\n                                                    <label for='input_11_1_6' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Last Name<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_11_2\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half gfield_contains_required field_sublabel_hidden_label gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Email Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_11_2_container'>\n                                <span id='input_11_2_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_2' id='input_11_2' value=''   placeholder='Your Email Address' aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_11_2' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Email Address<\/label>\n                                <\/span>\n                                <span id='input_11_2_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_2_2' id='input_11_2_2' value=''   placeholder='Confirm Your Email Address' aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_11_2_2' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Confirm Email Address<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/fieldset><div id=\"field_11_5\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_5'>Phone Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_5' id='input_11_5' type='tel' value='' class='medium'  placeholder='(XXX) XXX XXXX' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_11_77\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_77'>Province of Residence<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_77' id='input_11_77' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Alberta' >Alberta<\/option><option value='British Columbia' >British Columbia<\/option><option value='Manitoba' >Manitoba<\/option><option value='New Brunswick' >New Brunswick<\/option><option value='Newfoundland and Labrador' >Newfoundland and Labrador<\/option><option value='Nova Scotia' >Nova Scotia<\/option><option value='Ontario' >Ontario<\/option><option value='Prince Edward Island' >Prince Edward Island<\/option><option value='Quebec' >Quebec<\/option><option value='Saskatchewan' >Saskatchewan<\/option><option value='Northwest Territories' >Northwest Territories<\/option><option value='Nunavut' >Nunavut<\/option><option value='Yukon' >Yukon<\/option><\/select><\/div><\/div><div id=\"field_11_21\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half gfield_contains_required field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_21'>Date of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_21' id='input_11_21' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_11_21_date_format gfield_description_11_21\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_11_21_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_11_21' class='gform_hidden' value='https:\/\/travelguardian.ca\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><div class='gfield_description' id='gfield_description_11_21'>Please note that eligibility is limited to individuals aged below 80 years.<\/div><\/div><fieldset id=\"field_11_91\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Gender<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_11_91'>\n\t\t\t<div class='gchoice gchoice_11_91_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_91' type='radio' value='Female'  id='choice_11_91_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_11_91_0' id='label_11_91_0' class='gform-field-label gform-field-label--type-inline'>Female<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_91_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_91' type='radio' value='Male'  id='choice_11_91_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_11_91_1' id='label_11_91_1' class='gform-field-label gform-field-label--type-inline'>Male<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_91_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_91' type='radio' value='Other'  id='choice_11_91_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_11_91_2' id='label_11_91_2' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_11_63\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Consent to Contact and Use of Information<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_11_63'><div class='gchoice gchoice_11_63_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_63.1' type='checkbox'  value='By checking this box, you consent to Travel Guardian Insurance Ltd. and its insurance partners collecting, using, and sharing your personal information to contact you (by phone, email, or text) and to provide, manage, or renew your insurance quote or policy.'  id='choice_11_63_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_63_1' id='label_11_63_1' class='gform-field-label gform-field-label--type-inline'>By checking this box, you consent to Travel Guardian Insurance Ltd. and its insurance partners collecting, using, and sharing your personal information to contact you (by phone, email, or text) and to provide, manage, or renew your insurance quote or policy.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_11_86\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >You may <a href=\"https:\/\/travelguardian.ca\/en\/unsubscribe\/\" style=\"color:#2c7be5; font-weight:bold;\">\n    withdraw your consent\n<\/a> or update your communication preferences at any time. For details, see our <a href=\"https:\/\/travelguardian.ca\/en\/privacy-policy\/\" style=\"color:#2c7be5; font-weight:bold;\">\n    privacy policy\n<\/a>. If you do not consent, we\u2019re unable to complete your quote online \u2014 please call our licensed agents for assistance.\n<\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_11_62' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_11_2' class='gform_page' data-js='page-field-id-62' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_11_2' class='gform_fields top_label form_sublabel_above description_below validation_below'><div id=\"field_11_64\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Get a Health and Dental Quote<\/h3><div class='gsection_description' id='gfield_description_11_64'>Please fill out all of the required information, and one of our specialists will be in contact with you within 24 hours. Thank you for choosing Travel Guardian!<\/div><\/div><div id=\"field_11_55\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Family Information<\/h3><\/div><fieldset id=\"field_11_73\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Single or Family Coverage?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_11_73'>\n\t\t\t<div class='gchoice gchoice_11_73_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_73' type='radio' value='Single'  id='choice_11_73_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_11_73_0' id='label_11_73_0' class='gform-field-label gform-field-label--type-inline'>Single<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_73_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_73' type='radio' value='Couple'  id='choice_11_73_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_11_73_1' id='label_11_73_1' class='gform-field-label gform-field-label--type-inline'>Couple<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_73_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_73' type='radio' value='Family'  id='choice_11_73_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_11_73_2' id='label_11_73_2' class='gform-field-label gform-field-label--type-inline'>Family<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_11_17\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_17'>Number of Individuals (including primary person)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_17' id='input_11_17' class='medium gfield_select'  aria-describedby=\"gfield_description_11_17\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><\/select><\/div><div class='gfield_description' id='gfield_description_11_17'>Details for the primary person have already been recorded. For couples, this number should equal 2. For a family of 3 (i.e. couple and one child), this number should be 3, and so on.<\/div><\/div><div id=\"field_11_82\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >Your details are already recorded. If you need to make changes, please go back to Step 1.<\/div><div id=\"field_11_87\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >Your details are already recorded. If you need to update them, please return to Step 1. <strong> To add information for additional family members, simply change the number of individuals and the necessary fields will appear. <\/strong><\/div><fieldset id=\"field_11_26\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-half gfield_contains_required field_sublabel_hidden_label gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >1st Additional Family Member<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_11_26'>\n                            \n                            <span id='input_11_26_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_26.3' id='input_11_26_3' value=''   aria-required='true'   placeholder='First Name'  \/>\n                                                    <label for='input_11_26_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_11_26_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_26.6' id='input_11_26_6' value=''   aria-required='true'   placeholder='Last Name'  \/>\n                                                    <label for='input_11_26_6' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_11_97\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_97'>Date of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_97' id='input_11_97' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_11_97_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_11_97_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_11_97' class='gform_hidden' value='https:\/\/travelguardian.ca\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><fieldset id=\"field_11_23\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-half gfield_contains_required field_sublabel_hidden_label gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >2nd Additional Family Member<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_11_23'>\n                            \n                            <span id='input_11_23_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_23.3' id='input_11_23_3' value=''   aria-required='true'   placeholder='First Name'  \/>\n                                                    <label for='input_11_23_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_11_23_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_23.6' id='input_11_23_6' value=''   aria-required='true'   placeholder='Last Name'  \/>\n                                                    <label for='input_11_23_6' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_11_98\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_98'>Date of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_98' id='input_11_98' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_11_98_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_11_98_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_11_98' class='gform_hidden' value='https:\/\/travelguardian.ca\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><fieldset id=\"field_11_29\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-half gfield_contains_required field_sublabel_hidden_label gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >3rd Additional Family Member<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_11_29'>\n                            \n                            <span id='input_11_29_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_29.3' id='input_11_29_3' value=''   aria-required='true'   placeholder='First Name'  \/>\n                                                    <label for='input_11_29_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_11_29_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_29.6' id='input_11_29_6' value=''   aria-required='true'   placeholder='Last Name'  \/>\n                                                    <label for='input_11_29_6' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_11_99\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_99'>Date of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_99' id='input_11_99' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_11_99_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_11_99_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_11_99' class='gform_hidden' value='https:\/\/travelguardian.ca\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><fieldset id=\"field_11_35\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-half gfield_contains_required field_sublabel_hidden_label gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >4th Additional Family Member<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_11_35'>\n                            \n                            <span id='input_11_35_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_35.3' id='input_11_35_3' value=''   aria-required='true'   placeholder='First Name'  \/>\n                                                    <label for='input_11_35_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_11_35_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_35.6' id='input_11_35_6' value=''   aria-required='true'   placeholder='Last Name'  \/>\n                                                    <label for='input_11_35_6' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_11_100\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_100'>Date of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_100' id='input_11_100' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_11_100_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_11_100_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_11_100' class='gform_hidden' value='https:\/\/travelguardian.ca\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><fieldset id=\"field_11_32\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-half gfield_contains_required field_sublabel_hidden_label gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >5th Additional Family Member<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_11_32'>\n                            \n                            <span id='input_11_32_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_32.3' id='input_11_32_3' value=''   aria-required='true'   placeholder='First Name'  \/>\n                                                    <label for='input_11_32_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_11_32_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_32.6' id='input_11_32_6' value=''   aria-required='true'   placeholder='Last Name'  \/>\n                                                    <label for='input_11_32_6' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_11_101\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_101'>Date of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_101' id='input_11_101' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_11_101_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_11_101_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_11_101' class='gform_hidden' value='https:\/\/travelguardian.ca\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_11_74' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_11_74' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_11_3' class='gform_page' data-js='page-field-id-74' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_11_3' class='gform_fields top_label form_sublabel_above description_below validation_below'><div id=\"field_11_75\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Get a Health and Dental Quote<\/h3><div class='gsection_description' id='gfield_description_11_75'>Please fill out all of the required information, and one of our specialists will be in contact with you within 24 hours. Thank you for choosing Travel Guardian!<\/div><\/div><div id=\"field_11_54\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Additional Questions<\/h3><\/div><fieldset id=\"field_11_104\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Which benefits are you most interested in?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_11_104'><div class='gchoice gchoice_11_104_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_104.1' type='checkbox'  value='Health'  id='choice_11_104_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_104_1' id='label_11_104_1' class='gform-field-label gform-field-label--type-inline'>Health<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_11_104_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_104.2' type='checkbox'  value='Drugs'  id='choice_11_104_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_104_2' id='label_11_104_2' class='gform-field-label gform-field-label--type-inline'>Drugs<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_11_104_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_104.3' type='checkbox'  value='Dental'  id='choice_11_104_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_104_3' id='label_11_104_3' class='gform-field-label gform-field-label--type-inline'>Dental<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_11_80\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do you have group coverage that is about to expire?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_11_80'>\n\t\t\t<div class='gchoice gchoice_11_80_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_80' type='radio' value='Yes'  id='choice_11_80_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_11_80_0' id='label_11_80_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_80_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_80' type='radio' value='No'  id='choice_11_80_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_11_80_1' id='label_11_80_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_11_50\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_50'>When will your existing coverage expire?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_50' id='input_11_50' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_11_106\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do you have any current prescription medication that you require coverage for?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_11_106'>\n\t\t\t<div class='gchoice gchoice_11_106_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_106' type='radio' value='Yes'  id='choice_11_106_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_11_106_0' id='label_11_106_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_11_106_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_106' type='radio' value='No'  id='choice_11_106_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_11_106_1' id='label_11_106_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_11_102\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_102'>Please list medications below<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_102' id='input_11_102' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_11_103\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Preferred contact method<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_11_103'><div class='gchoice gchoice_11_103_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_103.1' type='checkbox'  value='Phone'  id='choice_11_103_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_103_1' id='label_11_103_1' class='gform-field-label gform-field-label--type-inline'>Phone<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_11_103_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_103.2' type='checkbox'  value='Email'  id='choice_11_103_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_103_2' id='label_11_103_2' class='gform-field-label gform-field-label--type-inline'>Email<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_11_88\" class=\"gfield gfield--type-captcha gfield--input-type-captcha gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_88'>CAPTCHA<\/label><div id='input_11_88' class='ginput_container ginput_recaptcha' data-sitekey='6Lfte1QrAAAAAEkbs9LoCBbpm7iSwhhk41sTq7zg'  data-theme='light' data-tabindex='0'  data-badge=''><\/div><\/div><\/div><\/div>\n        <div class='gform-page-footer gform_page_footer top_label'><input type='submit' id='gform_previous_button_11' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='submit' id='gform_submit_button_11' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Submit'  \/> <input type='hidden' name='gform_ajax' value='form_id=11&amp;title=&amp;description=&amp;tabindex=0&amp;theme=orbital&amp;styles=[]&amp;hash=1e8bbdd1965c52050a4fe6712a20266c' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_11' value='iframe' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_11' id='gform_theme_11' value='orbital' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_11' id='gform_style_settings_11' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_11' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='11' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='CAD' value='l\/MOSbLD7iZM2no8wZjMttAeKzjJUdmABJWJPECff4lTfSd41nvzAlkKZqxHGfYmi4g3khqgdNomiaXTUtuTrCJJ6x24q61hVXRpa3NoRMgqIDU=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_11' value='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' 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