Name of Tour: __________________________

Tour Code: __________________________

Departure Date: _________________________

EFTPOS NOW AVAILABLE

PASSENGER 1.

Title:   Mr       Mrs     Ms       Miss    (Please circle)

Surname:       ______________________

Given Name: (as ID)    ___________________

Date of Birth:          ________________

Address: (please advise if postal different)

__________________________________

____________________________________________________________________

E-mail address: ______________________

Home: _____________________________

Mobile Number: ______________________

Emergency Contact Name & Phone Number:

[Relative/Friend] – Please provide one or more:

__________________________________

Ph.: _______________________________

Relationship to Emergency Contact:

_________________________________

Special Requests including Dietary Needs:

Diet/Allergies/Gluten Free/Vegetarian/Coeliac

_______________________________________

_________________________________

Any Celebrations on Tour (e.g. Birthday, Anniversary)

(Date of Celebration): ___________________

Do you have a Walker? Yes:           No:

TRAVEL INSURANCE:

Policy No: ______________________

24hr Emergency Ph.: _________________

PASSENGER 2.

Title:   Mr       Mrs     Ms       Miss    (Please circle)

Surname:   ________________________

Given Name: (as ID) __________________

Date of Birth:          ________________

Address: (please advise if postal different)

_________________________________

_________________________________

_________________________________

E-mail address: _____________________

Home: ____________________________

Mobile Number: _____________________

Emergency Contact Name & Phone Number:

[Relative/Friend] – Please provide one or more:

_________________________________

Ph.: ______________________________

Relationship to Emergency Contact:

_________________________________

Special Requests including Dietary Needs:

Diet/Allergies/Gluten Free/Vegetarian/Coeliac

_______________________________________

_________________________________

Any Celebrations on Tour (e.g. Birthday, Anniversary)

(Date of Celebration): __________________

Do you have a Walker? Yes:           No:

_

TRAVEL INSURANCE:

Policy No: ________________________

24hr Emergency Ph.: _________________

I give Lamble Tours permission to use photographs, which I may be in, for advertising and promotional purposes:

SIGN: __________________________________    DATE: _____________

Do you require a Lamble Tours Badge?            Yes           No

Name for Badge:     _____________________________________________________

Accommodation Required: (Please circle)

          Single               Double              Twin            Willing to Twin Share

Name of person (if applicable) sharing accommodation:

                             _____________________________________________________

I have read, understood and accepted the Terms & Conditions:

        YES                                           NO      

Lamble Tours has offered to organise Travel Insurance:

       YES

I have declined Lamble Tours offer for Travel Insurance and will source independently.

        YES                                           NO      

I declare that the information given is true and correct and in the event of a change, I will notify Lamble Tours to advise anything that may affect my booking.

NAME: ____________________________________________________________

SIGNATURE: ________________________________ DATE: ______________

DEPOSIT:

$200 per person to secure Booking. Cheques made payable to: ‘Lamble Tours’

Direct Deposit:             ANZ     BSB No. 013623           Acct. No. 109287922

EFTPOS Available

LAMBLE TOURS                   Ph.: 5968-3310                   Mobile: 0418 853 810

ABN: 14 084 693 736

P.O. Box 230 Emerald Vic. 3782

Email: [email protected]