South America Travel Centre Booking Form

Your Name:

Your Email:

South America Travel Centre Consultant Name

Alana Cinzia Hayley Jennifer Rachel


Details of Travellers

Mr/Mrs/Ms Surname Given Names Date of Birth Occupation
1
2
3
4

 

Address:   Telephone:  
Address : (Home):
Postcode: (Bus):
Email: (Mob):

 
Passport Details

Passport No. Nationality Place of Issue Expiry date
1
2
3
4

 

Any special dietary requirements?
Traveller 1
Traveller 2
Traveller 3
Traveller 4

 
I/We confirm all persons named here are fit to travel and do not have any pre-existing medical conditions except those detailed below

Medical Conditions
Traveller 1
Traveller 2
Traveller 3
Traveller 4

 
Frequent Flyer Details

Frequent Flyer Airline Frequent Flyer No
Traveller 1
Traveller 2
Traveller 3
Traveller 4

 
Flight seating preference:

 
Room Type

DoubleTwin-share

Emergency Contact

 
Person to be contacted in case of emergency
Emergency Contact Telephone:
 
Departure date from Australia:

 

Declaration

By paying the deposit, I acknowledge I have read, understood and agree to abide by the Booking Conditions and I 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 and have read and accept the booking conditions.
Yes