Booking Form

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Personal Details

Title
Firstname
Lastname
	Above as per passport.
Address
Town or Suburb
State
Country
Post Code
Mobile
Daytime Phone
Email
Ability
Surfer Type
Allergies? If so please list

Travel Details

Consultant Name
Destination
Duration
Departure Date (DD-MM-YYYY)
Return Date (DD-MM-YYYY)
Charter / Boat Name
Resort / Camp / Tour Name

Frequent Flyer Membership #Frequent Flyer Membership #

Frequent Flyer Details
Details are Optional

Frequent Flyer Airline

Frequent Flyer Airline

Passport Details

Passport Number
Nationality
Date of Birth (DD-MM-YYYY)
Place Of Issue
Expiry Date (DD-MM-YYYY)
Emergency Contact's Name
Emergency Number

Booking Details

Booking Total Quoted $
Booking Deposit Required $
Security Code:	If you cannot read this image, click here for a new one.

Payment Details

Payment Option

Amount $

Travel Insurance
Travel Insurance - We can provide information to you about travel insurance. For details of the services we provide, including a quote, please refer to our Financial Services Guide. Travel Insurance is strongly recommended by the Department of Foreign Affairs and Trade for all overseas travel. I hereby declare I have been offered Travel Insurance by my consultant. Plase note : you are not covered by insurance until you have paid your policy premium and completed and returned to us the appropriate enrolment form.

Travel Insurance

Travel Insurance - We can provide information to you about travel insurance. For details of the services we provide, including a quote, please refer to our Financial Services Guide. Travel Insurance is strongly recommended by the Department of Foreign Affairs and Trade for all overseas travel. I hereby declare I have been offered Travel Insurance by my consultant.

Plase note : you are not covered by insurance until you have paid your policy premium and completed and returned to us the appropriate enrolment form.

Terms and Conditions
Click here to read very important Terms and Conditions I acknowledge that I am 18 years of age or older; and that I understand and accept the terms and conditions stated by The Perfect Travel Group found at the link provided above.

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