Individual Gold Lifeline Travel Application
Your Name
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E-mail Address
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Your Cell Number
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Date of Actual Trip
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Destination
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Method of Travel
By use of this Gold Lifeline Emergency Ride Card, the bearer of same agrees to indemnify and save harmless American Student Books, Inc., Student Lifeline, Gold Lifeline and any and all affiliates from any liabilities whether by acts of commission or omission, arising out of and relative to the services stated herein. Gold Lifeline shall provide payment up to $200.00 per ride during any legitimate emergency incident wherein the bearer/member requests emergency black car transportation while & during its stated travel arrangements cited on the application submitted, made either individually or with a travel agency. Nothing contained herein should be read or construed as an obligation on the part of the issuer of this certificate to supply a car ride for or to any authorized member each or any time or occasion that a call is placed to obtain a black car service and a ride is requested. Every emergency request is thoroughly pursued with absolute diligence and seriousness. *
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