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, SHOP 4 CLYDE STREET MALL, 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:___________________________________________________________________

Please refer to the conditions page of the tour you are interested in, which 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.