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SOUTH AMERICA TRAVEL CENTRE BOOKING FORM


Declaration
By completing this form and paying the deposit, I/we acknowledge and have read, understood and agree to abide by the Booking Conditions* and I/we consent to South America Travel Centre using any personal information provided by me for the purposes of making travel arrangements on my behalf.

In compliance with the government Privacy Act, we advise that we may use your personal details to send you information about future programmes.

I acknowledge the above statements


*Insurance
It is a condition of booking with Tailor-Made Journeys Pty Ltd (trading as South America/Antarctica/Arctic/Travel Centres & Luxury & Expedition Cruises) that you take out appropriate and adequate comprehensive travel insurance. We advise that you take out insurance before paying your deposit (which if often non-refundable) and certainly before paying the final balance. For more information on Insurance requirements and the policy we offer click here.




South America Travel Centre Consultant Name*

Alana Cinzia Hayley Jennifer Rachel Anna



Departure Date From Australia:


Details of Travellers (Please ensure that your details match your passport)



Booking Form Traveller 1 Details
Title Given Names* Surname* Date Of Birth* Occupation



Email Address*:


Phone - Mobile* Phone - Home Phone - Business



Postal Address*
Address:

Suburb* State* Postcode*



Dietary Requirements*:
Medical Conditions*:
Room Type: DoubleTwin-Share


Passport Details

Passport Number* Nationality* Place of Issue* (Authority) Expiry Date*



Frequent Flyer Details*

Airline Flyer No.



Insurance Details*

Policy Provider Policy Number
Please provide me a quote for insurance



Emergency Contact
Emergency Contact Name:
Phone Number:


If you were referred to us by a past client of ours, what is their name?



Booking Form Traveller 2 Details
Title Given Names Surname Date Of Birth Occupation



Email Address:


Phone - Mobile Phone - Home Phone - Business



Postal Address
Same As Traveller 1
Address:

Suburb State Postcode



Dietary Requirements:
Medical Conditions:
Room Type: DoubleTwin-Share


Passport Details

Passport Number Nationality Place of Issue (Authority) Expiry Date



Frequent Flyer Details

Airline Flyer No.



Insurance Details

Policy Provider Policy Number
No insurance yet



Emergency Contact
Same As Traveller 1
Emergency Contact Name:
Phone Number:


Booking Form Traveller 3 Details
Title Given Names Surname Date Of Birth Occupation



Email Address:


Phone - Mobile Phone - Home Phone - Business



Postal Address
Same As Traveller 1
Address:

Suburb State Postcode



Dietary Requirements:
Medical Conditions:
Room Type: DoubleTwin-Share


Passport Details

Passport Number Nationality Place of Issue (Authority) Expiry Date



Frequent Flyer Details

Airline Flyer No.



Insurance Details

Policy Provider Policy Number
No insurance yet



Emergency Contact
Same As Traveller 1
Emergency Contact Name:
Phone Number:


Booking Form Traveller 4 Details
Title Given Names Surname Date Of Birth Occupation



Email Address:


Phone - Mobile Phone - Home Phone - Business



Postal Address
Same As Traveller 1
Address:

Suburb State Postcode



Dietary Requirements:
Medical Conditions:
Room Type: DoubleTwin-Share


Passport Details

Passport Number Nationality Place of Issue (Authority) Expiry Date



Frequent Flyer Details

Airline Flyer No.



Insurance Details

Policy Provider Policy Number
No insurance yet



Emergency Contact
Same As Traveller 1
Emergency Contact Name:
Phone Number:


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