HOLIDAY NAME
Important: please complete your name as it appears on your passport
Title MRMRSMSMISSDRPROFOTHER
First Name
Middle Name/ s
Last Name
Preferred First Name (otherwise known as)
Email Address
Sex
Date of Birth
Home Address
Suburb State
Country
Postcode
Telephone (home)
Telephone (work)
Telephone (mobile)
Country of Birth
Nationality (as per your passport)
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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
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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
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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 [cf7mls_step cf7mls_step-4 "Back" "Next" "Step 4"]
I'd like a double roomI’d like a single roomI'd like to book a twin share room (for me and my friend)Other
Other room [cf7mls_step cf7mls_step-5 "Back" "Next" "Step 5"]
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 needsVegetarian (no meat / seafood)VeganI do not eat shellfish (crustaceans)I do not eat seafoodI do not eat chickenDo not eat porkI do not eat red meatI do not eat eggsDairy-free dietGluten-free dietI have a nut or peanut allergy
Other (please specify) [cf7mls_step cf7mls_step-6 "Back" "Next" "Step 6"]
Internet SearchI have travelled with you beforeTravel AgentNewspaper/Magazine/RadioFamily or friend
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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? YesNO
Participate in a sightseeing tour on foot with a duration of up to 2-3 hours? YesNO
Stand for extended periods without the need to sit? YesNO
Climb a few flights of stairs without duress and walk up short steep hills? YesNO
Carry your own luggage (up 23kg) and hand luggage without assistance (up to 7kg)? YesNO
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? YesNO
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.
I print name in full, agree 4wdmada Terms andConditions, and understand the cancellation penalties
Signed
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