Booking Success

PERSONAL DETAILS

Start date
End date
Titre
First Name
Last Name
Email Address
Date of Birth
Home Address
Country
Suburb State
Postcode
Country of Birth
Telephone (home)

PASSPORT DETAILS

Nationality
Passport Number:
Passport Place of Issue
Passport Date of Issue
Date of Expiry

TRAVEL INSURANCE

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

SPECIAL DIET REQUESTS

Selected Diet Options:

HOW DID YOU HEAR ABOUT US?

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.

Walk up to 2 kms, and on uneven surfaces without a mobility aid, duress or needing to take a break?	no
Participate in a sightseeing tour on foot with a duration of up to 2-3 hours?	No
Stand for extended periods without the need to sit?	No
Climb a few flights of stairs without duress and walk up short steep hills?	No
Carry your own luggage (up 23kg) and hand luggage without assistance (up to 7kg)?	No
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?

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?	no
Participate in a sightseeing tour on foot with a duration of up to 2-3 hours?	No
Stand for extended periods without the need to sit?	No
Climb a few flights of stairs without duress and walk up short steep hills?	No
Carry your own luggage (up 23kg) and hand luggage without assistance (up to 7kg)?	No
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?

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

Yes, I print name in full, agree 4wdmada Terms and Conditions, and understand the cancellation penalties.
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Thank you for booking with us!