CAP Membership Organizational Inquiry Form
Company Information
Organization Name
*
Organization Address (City, State, Country)
*
Brief Description of Organization
*
Type of Entity
*
Corp.
LLC
LLP
NGO
TMC
Academic
Insurance
Other
Point of Contact Name
*
POC Phone Number
*
Email
*
Existing Client
*
Yes
No
FocusPoint Representative
*
Greg Pearson
Peter Martin
Craig Colburn
David Mace
Ryan Hawley
Tanya McCuen
Lisa Arredondo
Michelle Otero
Michael Thompson
Maeve Davis
Joe Schollaert
Jim Rovers
Rob Shuster
Randy Haight
Lee Sharon
Maria Tere Septien
Other
More Details
Total Number of Proposed CAP Memberships (Minimum 20)
*
What is the Frequency of Travel
*
Occasionally
Daily
Weekly
Monthly
Quarterly
Semi-Annually
Annually
Please list the Countries of Travel
*
Aruba
Afghanistan
Angola
Anguilla
Albania
Andorra
Netherlands Antilles
United Arab Emirates
Argentina
Armenia
American Samoa
Antarctica
French Southern territories
Antigua and Barbuda
Australia
Austria
Azerbaijan
Burundi
Belgium
Benin
Burkina Faso
Bangladesh
Bulgaria
Bahrain
Bahamas
Bosnia and Herzegovina
Belarus
Belize
Bermuda
Bolivia
Brazil
Barbados
Brunei
Bhutan
Bouvet Island
Botswana
Central African Republic
Canada
Cocos (Keeling) Islands
Switzerland
Chile
China
Cote d'Ivoire
Cameroon
Congo, The Democratic Republic
Congo
Cook Islands
Colombia
Comoros
Cape Verde
Costa Rica
Cuba
Christmas Island
Cayman Islands
Cyprus
Czech Republic
Germany
Djibouti
Dominica
Denmark
Dominican Republic
Algeria
Ecuador
Egypt
Eritrea
Western Sahara
Spain
Estonia
Ethiopia
Finland
Fiji Islands
Falkland Islands
France
Faroe Islands
Federated States of Micronesia
Gabon
United Kingdom
Georgia
Ghana
Gibraltar
Guinea
Guadeloupe
Gambia
Guinea-Bissau
Equatorial Guinea
Greece
Grenada
Greenland
Guatemala
French Guiana
Guam
Guyana
Hong Kong
Heard Island and McDonald Isla
Honduras
Croatia
Haiti
Hungary
Indonesia
India
British Indian Ocean Territory
Ireland
Iran
Iraq
Iceland
Israel
Italy
Jamaica
Jordan
Japan
Kazakstan
Kenya
Kyrgyzstan
Cambodia
Kiribati
Saint Kitts and Nevis
South Korea
Kuwait
Laos
Lebanon
Liberia
Libyan Arab Jamahiriya
Saint Lucia
Liechtenstein
Sri Lanka
Lesotho
Lithuania
Luxembourg
Latvia
Macao
Morocco
Monaco
Moldova
Madagascar
Maldives
Mexico
Marshall Islands
Macedonia
Mali
Malta
Myanmar
Mongolia
Northern Mariana Islands
Mozambique
Mauritania
Montserrat
Martinique
Mauritius
Malawi
Malaysia
Mayotte
Namibia
New Caledonia
Niger
Norfolk Island
Nigeria
Nicaragua
Niue
Netherlands
Norway
Nepal
Nauru
New Zealand
Oman
Pakistan
Panama
Pitcairn
Peru
Philippines
Palau
Papua New Guinea
Poland
Puerto Rico
North Korea
Portugal
Paraguay
Palestine
French Polynesia
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saudi Arabia
Sudan
Senegal
Singapore
South Georgia and the South Sandwich Islands
Saint Helena
Svalbard and Jan Mayen
Solomon Islands
Sierra Leone
El Salvador
San Marino
Somalia
Saint Pierre and Miquelon
Sao Tome and Principe
Suriname
Slovakia
Slovenia
Sweden
Swaziland
Seychelles
Syria
Turks and Caicos Islands
Chad
Togo
Thailand
Tajikistan
Tokelau
Turkmenistan
East Timor
Tonga
Trinidad and Tobago
Tunisia
Turkey
Tuvalu
Taiwan
Tanzania
Uganda
Ukraine
United States Minor Outlying Islands
Uruguay
United States
Uzbekistan
Holy See (Vatican City State)
Saint Vincent and the Grenadin
Venezuela
Virgin Islands, British
Virgin Islands, U.S.
Vietnam
Vanuatu
Wallis and Futuna
Samoa
Yemen
Yugoslavia
South Africa
Zambia
Zimbabwe
What is the Average Trip Duration
*
0 to 7 days
7 to 14 days
14 to 30 days
30 plus days
Does the Organization have Expatriates and/or International Assignees
(?)
Individuals required to work outside of their home country for a continuous period lasting longer than ninety (90) days.
*
Yes
No
Number of Expatriates/International Assignees(If Expats only for Memberships, Minimum 20)
(?)
Individuals required to work outside of their home country for a continuous period lasting longer than ninety (90) days.
Please List the Deployment Location(s) of Expatriates/International Assignees
Aruba
Afghanistan
Angola
Anguilla
Albania
Andorra
Netherlands Antilles
United Arab Emirates
Argentina
Armenia
American Samoa
Antarctica
French Southern territories
Antigua and Barbuda
Australia
Austria
Azerbaijan
Burundi
Belgium
Benin
Burkina Faso
Bangladesh
Bulgaria
Bahrain
Bahamas
Bosnia and Herzegovina
Belarus
Belize
Bermuda
Bolivia
Brazil
Barbados
Brunei
Bhutan
Bouvet Island
Botswana
Central African Republic
Canada
Cocos (Keeling) Islands
Switzerland
Chile
China
Cote d'Ivoire
Cameroon
Congo, The Democratic Republic
Congo
Cook Islands
Colombia
Comoros
Cape Verde
Costa Rica
Cuba
Christmas Island
Cayman Islands
Cyprus
Czech Republic
Germany
Djibouti
Dominica
Denmark
Dominican Republic
Algeria
Ecuador
Egypt
Eritrea
Western Sahara
Spain
Estonia
Ethiopia
Finland
Fiji Islands
Falkland Islands
France
Faroe Islands
Federated States of Micronesia
Gabon
United Kingdom
Georgia
Ghana
Gibraltar
Guinea
Guadeloupe
Gambia
Guinea-Bissau
Equatorial Guinea
Greece
Grenada
Greenland
Guatemala
French Guiana
Guam
Guyana
Hong Kong
Heard Island and McDonald Isla
Honduras
Croatia
Haiti
Hungary
Indonesia
India
British Indian Ocean Territory
Ireland
Iran
Iraq
Iceland
Israel
Italy
Jamaica
Jordan
Japan
Kazakstan
Kenya
Kyrgyzstan
Cambodia
Kiribati
Saint Kitts and Nevis
South Korea
Kuwait
Laos
Lebanon
Liberia
Libyan Arab Jamahiriya
Saint Lucia
Liechtenstein
Sri Lanka
Lesotho
Lithuania
Luxembourg
Latvia
Macao
Morocco
Monaco
Moldova
Madagascar
Maldives
Mexico
Marshall Islands
Macedonia
Mali
Malta
Myanmar
Mongolia
Northern Mariana Islands
Mozambique
Mauritania
Montserrat
Martinique
Mauritius
Malawi
Malaysia
Mayotte
Namibia
New Caledonia
Niger
Norfolk Island
Nigeria
Nicaragua
Niue
Netherlands
Norway
Nepal
Nauru
New Zealand
Oman
Pakistan
Panama
Pitcairn
Peru
Philippines
Palau
Papua New Guinea
Poland
Puerto Rico
North Korea
Portugal
Paraguay
Palestine
French Polynesia
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saudi Arabia
Sudan
Senegal
Singapore
South Georgia and the South Sandwich Islands
Saint Helena
Svalbard and Jan Mayen
Solomon Islands
Sierra Leone
El Salvador
San Marino
Somalia
Saint Pierre and Miquelon
Sao Tome and Principe
Suriname
Slovakia
Slovenia
Sweden
Swaziland
Seychelles
Syria
Turks and Caicos Islands
Chad
Togo
Thailand
Tajikistan
Tokelau
Turkmenistan
East Timor
Tonga
Trinidad and Tobago
Tunisia
Turkey
Tuvalu
Taiwan
Tanzania
Uganda
Ukraine
United States Minor Outlying Islands
Uruguay
United States
Uzbekistan
Holy See (Vatican City State)
Saint Vincent and the Grenadin
Venezuela
Virgin Islands, British
Virgin Islands, U.S.
Vietnam
Vanuatu
Wallis and Futuna
Samoa
Yemen
Yugoslavia
South Africa
Zambia
Zimbabwe
Has the organization ever experienced the following:
Evacuation Due to Medical Issues
Evacuation Due to Security-Related Issues
If checked, please explain
Does the organization have any of the following:
Existing BTA (Business Travel Accident policy) - If checked, please list:
(?)
Insurance policy that covers employees during a period of business travel.
Existing TRM Provider - If checked, please list:
(?)
Travel Risk Management companies that provides resources for medical, security, and advisory evacuation services for domestic and international travelers.
Existing TMC Provider - If checked, please list:
(?)
Travel Management Company is a travel agent or business travel agency that fully manages the business travel requirements delegated by individuals, companies and organizations.
MID/Back Office Provider - If checked, please list:
(?)
Web-based centralized systems used by travel agencies to manage reservations and confirmations of hotels, flights, and car rentals for their travelers.
GDS - If checked, please list:
(?)
Global Distribution Systems that provides real time availability from a pool of travel industry carriers to book flights, hotels, and car rentals.
Existing Tracker Product - If checked, please list:
(?)
Web-based product that provides organizations with a cumulative view of employee travel itineraries, monitor real-time travel advisories and alerts, communicate those alerts to traveling personnel, and can provide reporting tools for country risk analysis prior to employee travel.
What is the Annual Estimated PNR (Passenger Name Record) Volume
(?)
Travel record that contains data such as dates of travel, ticket information, contact details, means of payment, travel agent, seat number, baggage information, etc. and is booked by or for individuals or groups of an organization.
IATA No.
(?)
International Air Transport Association numeric code used by travel agents and cargo agents.
Quote Request
Quote(s) Requested (Please check all that apply)
Core CAP™
(?)
Fully funded travel assistance membership program that provides unlimited crisis consultation and coordinated, in-country response to 10 security-centric travel risks that impacts or has the potential to impact members during a period of travel.
CAPMED™
(?)
Includes Core CAP and coordinated, in-country response to medical mishaps (injury or illness) that occur during a period of travel, up to and including medical evacuation to a home hospital of choice.
Travel Tracker
(?)
Web-based product that provides organizations with a cumulative view of employee travel itineraries, monitor real-time travel advisories and alerts, communicate those alerts to traveling personnel, and can provide reporting tools for country risk analysis prior to employee travel.
MyTrac - Number of Devices to be Tracked
(?)
Advanced GPS technology used to track, locate, monitor, and manage the movement of people and identify their exact geo specific location worldwide. Installed on GPS devices with panic and emergency buttons, global mobile tracking, and monitored by our Crisis Response Center (CRC).
Special Conditions/Notes
CAP Reseller Information
CAP Reseller
Yes
No
Reseller Name
Submitted By
Name
*
Phone
*
Email
*