** BOOKING REQUEST Australia v Wales Weekend Package

PASSENGER ONE

Preferred Title *

If your preferred title is 'OTHER' please specify what that is

Passenger First Name (as shown in your passport) *

Passenger Surname (as shown in your passport) *

PASSENGER ONE CONTACT DETAILS

Email *

Mobile *

Home Phone

Work Phone

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Passenger ONE Signature *

Use your mouse to sign on a laptop or finger on a tablet or smartphone.

There is a Second Person Travelling On This Booking? *

YES
NO

PASSENGER TWO

Passenger Two Preferred Title *

If your preferred title is 'OTHER' please specify what that is

Passenger First Name (as shown in your passport) *

Passenger Surname (as shown in your passport) *

PASSENGER TWO CONTACT DETAILS

Are your contact details the SAME as Passenger One?

YES
NO

Email *

Mobile *

Home Phone

Work Phone

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Passenger TWO Signature

Use your mouse to sign on a laptop or finger on a tablet or smartphone.

ACCOMMODATION REQUIRED

** Package Required - 2 NIGHTS - Saturday 23- September - Monday 25 September 2023 **

4 Star (European Standard) Radisson Blu Lyon, Cat 3 Aust v Wales tkts: $2,050.00 per person twin share

** Package Required - 3 NIGHTS - Friday 22 September - Monday 25 September 2023 ** (copy)

4 Star (European Standard) Hotel Crowne Plaza Cité Internationale, Cat 3 Aust v Wales tkts: $2,490.00 per person twin share

Room Requirements *

Double room
Single Room (Supplement applies)

Room Requirements *

Double room
Single Room (Supplement applies)

If you wish to share a room with someone not listed on this form, please provide their full name if known.

General Comments

TRAVEL INSURANCE (Highly Recommended) *

YES Please CLICK HERE for your travel insurance quote
NO Thanks

DEPOSIT PAYMENT DETAILS. Full payment required *

BPAY (an invoice will be emailed to you with payment details)
Mastercard
Visa
AMEX (1% surcharge applies for AMEX Transactions).

CREDIT CARD HOLDERS NAME *

CREDIT CARD NUMBER *

EXPIRY DATE *

CVV *

Amount to be debited *

Signature of credit card holder *

Use your mouse to sign on a laptop or finger on a tablet or smartphone.

BOOKING TERMS & CONDITIONS *

I confirm that I accept the Gullivers Sport Travel Booking Terms & Conditions on behalf of all people listed on this booking form. *