Page 170 - Worldwide Adventures

BOOKING FORM
To join one of our trips, please complete this form and send it to your nearest World Expeditions o ce or your local travel agent, together with a non-refundable deposit: $400 per person (per trip) or 25% per person for Antarctic, Arctic and Russian Far East tours or 30% per person for Silver Explorer voyages (or USD$2500 on the Polar Pioneer; or $1500 on the Ushuaia). On receipt of the form, we will send you a con rmation kit covering all aspects of your selected adventure(s). Please check the speci c trip notes on our website regarding varied deposit amounts or nal payment deadlines.
PARTICIPANT 1 DETAILS BELOW TO BE PROVIDED AS IT APPEARS IN YOUR PASSPORT
TITLE: cMR cMRS cMISS cMS cDR cOTHER SURNAME:
FIRST NAME:
ADDRESS:
SUBURB/CITY:
TEL: (MOB)
EMAIL:
DATE OF BIRTH: (DD/MM/YR)
DO YOU HAVE A PRE-EXISTING MEDICAL CONDITION? c YES IF YES, PLEASE PROVIDE DETAILS
DO YOU HAVE SPECIAL DIETARY REQUIREMENTS? c YES IF YES, PLEASE PROVIDE DETAILS:
EMERGENCY
CONTACT: RELATIONSHIP:
MOBILE: EMAIL:
/
STATE: POSTCODE: (LAND) ( ) OCCUPATION:
/ HEIGHT (IN CM):
c NO c NO
PARTICIPANT 2 DETAILS BELOW TO BE PROVIDED AS IT APPEARS IN YOUR PASSPORT
TITLE: cMR cMRS cMISS cMS cDR cOTHER SURNAME:
FIRST NAME:
ADDRESS:
SUBURB/CITY:
TEL: (MOB)
EMAIL:
DATE OF BIRTH: (DD/MM/YR)
DO YOU HAVE A PRE-EXISTING MEDICAL CONDITION? c YES IF YES, PLEASE PROVIDE DETAILS
DO YOU HAVE SPECIAL DIETARY REQUIREMENTS? c YES IF YES, PLEASE PROVIDE DETAILS:
EMERGENCY
CONTACT: RELATIONSHIP:
MOBILE: EMAIL:
/
STATE: POSTCODE: (LAND) ( ) OCCUPATION:
/ HEIGHT (IN CM):
c NO c NO
PASSPORT DETAILS – optional, not required at time of booking
NATIONALITY:
PASSPORT NUMBER:
DATE OF ISSUE: (DD/MM/YR) / / EXPIRY DATE: / /
PASSPORT DETAILS – optional, not required at time of booking
NATIONALITY:
PASSPORT NUMBER:
DATE OF ISSUE: (DD/MM/YR) / / EXPIRY DATE: / /
TRIPS SELECTED
TRIP NAME:
TRIP NAME:
DO YOU REQUIRE FLIGHTS?
FREQUENT FLYER NUMBER & AIRLINE:
ROOM PREFERENCE (IF BOOKING FOR TWO): TWIN BEDS: c DOUBLE BEDS: c ADDITIONAL ARRANGEMENTS OR EXTENSIONS IF REQUIRED:
DEPARTURE DATE: / / ALTERNATIVE DATE: / /
c NO
RESPONSIBLE TRAVEL – CARBON OFFSET
DEPARTURE DATE: / / ALTERNATIVE DATE: / / c ECONOMY c OTHER FROM/TO [CITY]
c YES
IF YES,
c BUSINESS
I would like to offset 1 tonne of carbon produced by my air travel (approx. NZD $28.00): c YES c NO NOTE: If you decide to offset a portion of your flight this will appear on your Tax Invoice.
SEATING PREFERENCE:
WOULD YOU LIKE TO RECEIVE YOUR DEPARTURE INFORMATION AND TRAVEL DOCUMENT BY: OPTION 1: EMAIL c OR OPTION 2: NORMAL POST c HAVE YOU TRAVELLED WITH US BEFORE? c YES c NO WHERE DID YOU HEAR ABOUT US?
IN SIGNING THIS BOOKING FORM, I ACKNOWLEDGE THAT I HAVE READ, UNDERSTOOD AND ACCEPT THE CONDITIONS OF CONTRACT ACCOMPANYING THIS BOOKING AND THE OBLIGATIONS SET OUT IN THE CONDITIONS, PARTICULARLY THOSE RELATING TO THE RELEASE AND WAIVER OF LIABILITY [CONDITION 19], IF AGED UNDER 18, THIS FORM REQUIRES THE SIGNATURE OF YOUR PARENT OR LEGAL GUARDIAN.
PARTICIPANT 1: PARTICIPANT 2:
SIGNED: DATE: / / SIGNED: DATE: / /
CREDIT CARD DETAILS – PARTICIPANT 1
c VISA c MASTERCARD c AMEX c CHEQUE CARDHOLDER'SNUMBER:cccccccccccccccc
EXPIRY DATE: / SIGNATURE: CARDHOLDERS NAME:
AMOUNT:
CREDIT CARD DETAILS – PARTICIPANT 2
c VISA c MASTERCARD c AMEX c CHEQUE CARDHOLDER'SNUMBER:cccccccccccccccc
EXPIRY DATE: / SIGNATURE: CARDHOLDERS NAME:
AMOUNT:
SEND YOUR BOOKING FORM TO:
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