MACLEAY VALLEY TRAVEL - BOOKING FORM

ATTACH A PHOTOCOPY OF YOUR PASSPORT TO THIS BOOKING FORM

PLEASE PRINT OUT THIS BOOKING FORM AND SEND THE COMPLETED FORM TO:
MACLEAY VALLEY TRAVEL, 33 SMITH STREET, KEMPSEY NSW 2440

PLEASE PRINT DETAILS CLEARLY IN BLOCK LETTERS

Tour Name:____________________________________ Departure Date:____________________________

Name of Passenger 1 (as written in passport) ________________________________________________

Title: MR/MRS/MS/DR Age: _____________________ Date of Birth: ________________________________

Passport Nationality: ______________________________________________________________________

Passport Number & Expiry Date: _____________________________________________________________
(Passports must have 6 months validity from the time of tour completion)

Name of Passenger 2 (as written in passport)_________________________________________________

Title: MR/MRS/MS/DR Age: ___________________ Date of Birth: __________________________________

Passport Nationality: ______________________________________________________________________

Passport Number & Expiry Date: _____________________________________________________________
(Passports must have 6 months validity from the time of tour completion)

Address: _______________________________________________________________________________

State: __________________ Postcode: ________________ Email: _________________________________

Telephone / Fax Number: ___________________________ Mobile: _________________________________

Single Room / Twin Beds or Twin Share / Double Bed: (Room type is subject to availability)

Circle which airport you wish to depart from: SYDNEY / MELBOURNE / BRISBANE

Special Dietary Needs: _____________________________________________________________________

Optional Extensions: (if applicable) ___________________________________________________________

Do you want to receive details of SureSave travel insurance?: YES / NO (Please Circle)

If NO, please advise of alternative: __________________________________________________________

Do you have any existing medical conditions? __________________________________________________

In case of emergency, please notify:

Name: ________________________________________ Phone Number: ____________________________

Address: _____________________________________________Relationship: ________________________

Please return this form with your non-refundable deposit payment. The conditions page of the tour you are interested in states the amount of the deposit required.

DECLARATION: I have read and understand fully the booking conditions and I accept them.

Signature: ________________________________ Date: _________________________________

A copy of your passport is required to verify spelling of names. If this is not provided and the information we have for the airline is incorrect and the ticket is issued, then the airline will charge a re-issue fee.