Booking Form

Your travel consultant is:

Tour Title

Tour Date

Title

Surname

First Name

Middle Name/s

Preferred First Name

Address

City State/Postcode

Home Phone

Work Phone

Mobile Phone

Fax Number

Occupation

Employer

Business Address

Travel Isurance Details

Emergency Contact

Passport Number

Place of Issue

Issue Date

Expiry Date

Date of Birth

Nationality as shown on passport

Please specify any pre-existing medical condition(s)

Frequent Flyer Nos./Airlines

Dietary Requirements

Special Requirements

Rooming

Twin Double (on request only) Single

How did you hear about Travel Directors?

Do you wish to upgrade?

Business Class Premium Economy (if available) No

Are you thinking of extending your tour?

Yes No

Name

Date of Birth

Tour Title

Departure Date

No. of Days

Do you have any physical disabilities necessitating the use of a wheelchair or other walking aids?

Do you have a history of any significant medical (physical or mental( or surgical problems? If yes please state condition and medication required.

Will you be carrying the prescribed medication? If so please advise what type of medication and that you have sufficient quantities for the duration of the tour.

Do you suffer from a condition that may require emergency assistance? If so, please advise what type of assistance may be required.

Do you consider yourself to be fit and well, and fully able to undertake the proposed tour? This may include walks of up to 3kms (at a reasonable pace), climbing stairs, standing and other activities as specified in the brochure.

Declaration

I acknowledge that I have read and understood the information contained in the Travel Directors booking form, together with the health and fitness requirements sheet, that I understand the Conditions of Contractand join with Travel Directors in agreeing and accepting all conditions.

Date

Signature

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Asia

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Latin America & The Caribbean

Rail Tours

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Booking Form