Booking Form | Arctic Travel Centre

Antarctica Travel Centre specialises in selecting the right voyage for you as well as putting together pre and post voyage arrangements in South America so you get the most out of your trip of a lifetime. The more detail you can provide us with, the better. Please complete this form to tell us about your travel plans so that we may create an itinerary and provide you with a quote.

Antarctica Travel Centre Consultant Name


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

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

	Passport No.	Nationality	Place of Issue	Expiry date
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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 Airline	Frequent Flyer No
Traveller 1
Traveller 2
Traveller 3
Traveller 4

Room type	SmokingNon-smoking

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 Antarctica 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.

Any special dietary requirements?

Declaration:

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