4wdmada Booking Form

Please complete this form and return to your travel agent when you book your holiday.

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PERSONAL DETAILS

Important: please complete your name as it appears on your passport
Start date
End date
Title*
First Name*
Last Name*
Email Address*
Date of Birth
Home Address*
Country*
Suburb State*
Postcode*
Country of Birth*
Telephone*

PASSPORT DETAILS

Note: your passport should have at least 6 months validity for travel to most destinations outside your home country, from your return date of your holiday
Nationality*
Passport Number*
Passport Place of Issue*
Passport Date of Issue*
Date of Expiry*

TRAVEL INSURANCE

We require your policy details and a copy of your policy certificate. These details must be provided no later than 60 days prior to departure.
Travel Insurance Provider
Policy Number
Insurance Provider 24hr Contact Number

EMERGENCY CONTACT

Emergency Contact Name in Full
Contact’s relationship to you
Their Telephone Number
Emergency Contact’s address
Contact’s email
Their Other Number e.g Mobile

ROOM REQUEST

I'd like a double room
I’d like a single room
I'd like to book a twin share room (for me and my friend)

SPECIAL DIET REQUESTS

Please note: some special diet requests cannot be catered for while touring and/or on modes of transport. Please check with us before booking for any queries about your special diet requests.
No special diet needs Vegetarian (no meat / seafood)
Vegan I do not eat shellfish (crustaceans)
I do not eat seafood I do not eat chicken
I do not eat pork I do not eat red meat
I do not eat eggs Dairy-free diet
Gluten-free diet I have a nut or peanut allergy

HOW DID YOU HEAR ABOUT US?

Internet Search Newspaper/Magazine/Radio
I have travelled with you before Family or friend
Travel Agent

HEALTH & FITNESS

There is a minimum physical ability required for joining our tours. Passengers must be independent, with reasonable fitness. While on tour good mobility is needed for sightseeing excursions, boarding or alighting transport and climbing stairs. You must meet these minimum requirements for general touring. Note: some tours have physical demands that exceed these minimum requirements. If you are unsure, please check with us prior to booking.

Following are our minimum fitness requirements. Please advise if you meet these requirements. Can you:

Walk up to 2 kms, and on uneven surfaces without a mobility aid, duress or needing to take a break?

Participate in a sightseeing tour on foot with a duration of up to 2-3 hours?

Stand for extended periods without the need to sit?

Climb a few flights of stairs without duress and walk up short steep hills?

Carry your own luggage (up 23kg) and hand luggage without assistance (up to 7kg)?

If you are 70 years of age or older at the time of travel you will need to complete our Fit To Travel form (or 65 years or older for active trips). Please request this form from your travel agent.
Any allergies?

If yes, detail:
Detail any physical or mental health conditions, including medications, recent surgery, and if you use a CPAP machine:

In some instances, in addition to this booking form we may require that your doctor complete a Fit To Travel form that confirms you meet the physical and mental demands of the tour. If there are changes to your health following submission of this form you must notify us immediately

OTHER COMMENTS

TERMS AND CONDITIONS

I print name in full, agree 4wdmada Terms and Conditions, and understand the cancellation penalties. I print name in full, agree 4wdmada Terms and Conditions, and understand the cancellation penalties.
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