Other: HEALTH AND TRAVEL INSURANCE: Have you purchased travel insurance for your trip? O No °Yes. insurance company name:_____ _ _ _ Name of Health Insurance Company in US: YOUR STAY IN RUSSIA: Russian Cities to be Visited: List the details of the places you will stay in Russia: Name of First Hotel or Privat

e 0 Other: HEALTH AND TRAVEL INSURANCE: Have you purchased travel insurance for your trip? O No O Yes, insurance company name:___ _ _ Name of Health Insurance Company in US: YOUR STAY IN RUSSIA: Russian Cities to be Visited: List the details of the places you will stay in Russia: Name of First Hotel or Private

0 Other: HEALTH AND TRAVEL INSURANCE: Have you purchased travel insurance for your trip? O No O Yes, insurance company name:___ _ _ _ Name of Health Insurance Company in US: YOUR STAY IN RUSSIA: Russian Cities to be Visited: List the details of the places you will stay in Russia: Name of First Hotel or Private

0 Other: HEALTH AND TRAVEL INSURANCE: Have you purchased travel insurance for your trip? O No O Yes, insurance company name:___ _ _ _ Name of Health Insurance Company in US: YOUR STAY IN RUSSIA: Russian Cities to be Visited: List the details of the places you will stay in Russia: Name of First Hotel or Private