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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    4

     

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

     

    Passport No. Nationality Place of Issue Expiry date
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    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.