BOOKING REQUEST ‘Cruise Tour’ 15 – 26 September 2023

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) *

PASSPORT DETAILS PASSENGER ONE

Please only complete if your passport will be valid for at least 6 months from the date of your departure in 2023

Passport Number

Passport Date of Issue

Passport Date of Expiry

Passport Issuing Country

Passenger Nationality

Date of Birth *

DD/MM/YY

Place of Birth

PASSENGER ONE CONTACT DETAILS

Email *

Mobile *

Home Phone

Work Phone

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Special Requirements (dietary, medical conditions etc)

Passenger ONE Upload the photo page of your passport (not mandatory at this stage of booking)

Click or drag files to this area to upload. You can upload up to 2 files.

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) *

PASSPORT DETAILS PASSENGER TWO

Please only complete if your passport will be valid for at least 6 months from the date of your departure in 2023

Passport Number

Passport Date of Issue

Passport Date of Expiry

Passport Issuing Country

Passenger Nationality

Date of Birth *

DD/MM/YY

Place of Birth

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

Special Requirements (dietary, medical conditions etc)

Passenger TWO Upload the photo page of your passport (not mandatory at this stage of booking)

Click or drag files to this area to upload. You can upload up to 2 files.

Passenger TWO Signature

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

ACCOMMODATION

Accommodation Required *

TWIN SHARE (two beds per room)
DOUBLE (one double bed per room)
SINGLE (single supplement applies)

Cabin Required *

Classic Cabin $11,410 per person
French Balcony Cabin $13,210 per person
Deluxe Balcony Cabin $13,910 per person

If you are sharing with someone not listed on this form, please provide their name below.

General Comments

TRAVEL INSURANCE (Highly Recommended) *

YES Please CLICK HERE for your travel insurance quote
NO Thanks

DEPOSIT PAYMENT DETAILS ($10,000 deposit) *

BPAY (an invoice will be emailed to you with payment details)
Mastercard
Visa
AMEX (will incur a 1 % surcharge)

CREDIT CARD HOLDERS NAME *

CREDIT CARD NUMBER *

EXPIRY DATE *

CVV *

Amount to be debited *

Signature of credit card holder *

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.