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Registration for Medi-Aid Tourism plus ...

*Required Fields

Surname(s)* 
First Name(s)* 
Date of birth 
Place of birth 
Nationality 
Home address 
Email address 
Date of entry into Cameroon 
Date of departure 
   
Additional information to MEDI-AID
   
In case I do not have to make use of the insurance I would like to the following person to benefit from the amount of my premium paid.
Surname(s)* 
First Name(s)* 
Date of birth 
Place of birth 
Address 
   
   

For my trip to Cameroon I herewith apply for the "MEDI-AID Tourism Plus" health insurance to provide medical insurance cover for me throughout the duration of my stay in Cameroon. I will transfer the amount of 50 Euro as insurance premium. Upon receipt of this sum by MEDI-AID Cameroon I will receive a list of names, addresses and telephone numbers of the MEDI-AID offices in Cameroon.
www.medi-aid.org