Incentive Trip Registration - Retailers Insurance Company

Agency Participant

Agency Name(Required)

Agency City(Required)

Agent Participant

Name must be entered as it appears on your passport. Passports must be valid for six months after arrival date for entry.

Last Name(Required)

First Name(s)(Required)

Middle Name(s)(Required)

Gender(Required)

Passport #(Required)

Cell Phone Number(Required)

Email Address(Required)

Known Traveler # (TSA Pre-Check)

Delta SkyMiles #

If yes, please list or provide additional details on your allergy.

If yes, please provide additional details.

Guest Information

Name must be entered as it appears on your passport. Passports must be valid for six months after arrival date for entry.

Last Name(Required)

First Name(s)(Required)

Middle Name(s)(Required)

Gender(Required)

Passport #(Required)

Cell Phone Number(Required)

Email Address(Required)

Known Traveler # (TSA Pre-Check)

Delta SkyMiles #

If yes, please list or provide additional details on your allergy.

If yes, please provide additional details.

Emergency Contact

Phone Number(Required)

Relationship(Required)

Departing Airport

Secrets St. Lucia

Type of Room Choice(Required)

Our trip is scheduled for March 1, 2026, to March 5, 2026, and requires a connection. Additional nights may be secured and are dependent on availability, but you must maintain one of the scheduled arrival/departure dates.

If you haven’t earned an additional night by earning additional points, each additional night stay will result in a room charge of $1,201. Payment must be made prior to arrival. A link will be sent by the resort to your email address.

Confirmation

Who completed the information?(Required)

To ensure a correct communication channel, let us know who has completed this form. Thank you!

Email(Required)

Additional Comments

If you would like to speak with the travel agent about upgrading your seats, please add a note here. We will then convey your interest to the agent and ask that they review the inventory and contact you to discuss the opportunities.

St Lucia 2026 Registration Form