Booking Form - Galapagos Cruise Travel Centre

Declaration
By completing this form and paying the deposit, I/we acknowledge and have read, understood and agree to abide by the Booking Conditions* and I/we consent to Galapagos Cruise 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.

Declaration acknowledgement

I acknowledge the above statements

*Insurance
It is a condition of booking with Tailor-Made Journeys Pty Ltd (trading as Galapagos Cruise Travel Centre/ South America/Antarctica/Arctic/Travel Centres & Luxury & Expedition Cruises ) that you take out appropriate and adequate comprehensive travel insurance. We advise that you take out insurance before paying your deposit (which if often non-refundable) and certainly before paying the final balance. For more information on Insurance requirements and the policy we offer click here.

Galapagos Cruise Travel Centre Consultant Name

Alex

Cinzia

Rachel

Jennifer

Departure Date from Australia:

DETAILS OF TRAVELLERS (PLEASE ENSURE THAT YOUR DETAILS MATCH YOUR PASSPORT)

BOOKING FORM TRAVELLER 1 DETAILS

Title

Given Names

Surname

Date of Birth

Occupation

Email

Phone - Mobile

Phone - Home

Phone - Business

Postal Address*

Address:

Suburb

State

Postcode

Further Details*

Dietary Requirements

Medical Conditions

Room Type

Double

Twin Share

Passport Details

Passport Number

Nationality

Place of Issue (Authority)

Expiry Date

Frequent Flyer Details*

Airline

Flyer No.

Insurance Details*

Policy Provider

Policy Number

Insurance quote

Please quote me for insurance

Emergency Contact

Emergency Contact Name

Emergency Contact Phone Number

If you were referred to us by a past client of ours, what is their name?

BOOKING FORM TRAVELLER 2 DETAILS

Title (*required)

Given Names (*required)

Surname (*required)

Date of Birth (*required)

Occupation (*required)

Email (*required)

Phone - Mobile (*required)

Phone - Home

Phone - Business (*required)

Postal Address*

Postal same as traveller 1

Same As Traveller 1

Address: (*required)

Suburb (*required)

State (*required)

Postcode

Further Details*

Dietary Requirements (*required)

Medical Conditions (*required)

Room Type (*required)

Double

Twin Share

Passport Details

Passport Number (*required)

Nationality (*required)

Place of Issue (Authority) (*required)

Expiry Date

Frequent Flyer Details*

Airline (*required)

Flyer No. (*required)

Insurance Details*

Policy Provider (*required)

Policy Number (*required)

Insurance quote

Please quote me for insurance

Emergency Contact

Emergency same as traveller 1

Same As Traveller 1

Emergency Contact Name (*required)

Emergency Contact Phone Number (*required)

BOOKING FORM TRAVELLER 3 DETAILS

Title (*required)

Given Names (*required)

Surname (*required)

Date of Birth (*required)

Occupation (*required)

Email (*required)

Phone - Mobile (*required)

Phone - Home

Phone - Business (*required)

Postal Address*

Postal same as traveller 1

Same As Traveller 1

Address: (*required)

Suburb (*required)

State (*required)

Postcode

Further Details*

Dietary Requirements (*required)

Medical Conditions (*required)

Room Type (*required)

Double

Twin Share

Passport Details

Passport Number (*required)

Nationality (*required)

Place of Issue (Authority) (*required)

Expiry Date

Frequent Flyer Details*

Airline (*required)

Flyer No. (*required)

Insurance Details*

Policy Provider (*required)

Policy Number (*required)

Insurance quote

Please quote me for insurance

Emergency Contact

Emergency same as traveller 1

Same As Traveller 1

Emergency Contact Name (*required)

Emergency Contact Phone Number (*required)

BOOKING FORM TRAVELLER 4 DETAILS

Title (*required)

Given Names (*required)

Surname (*required)

Date of Birth (*required)

Occupation (*required)

Email (*required)

Postal Address*

Postal same as traveller 1

Same As Traveller 1

Address: (*required)

Suburb (*required)

State (*required)

Postcode

Further Details*

Dietary Requirements (*required)

Medical Conditions (*required)

Room Type (*required)

Double

Twin Share

Passport Details

Passport Number (*required)

Nationality (*required)

Place of Issue (Authority) (*required)

Expiry Date

Frequent Flyer Details*

Airline (*required)

Flyer No. (*required)

Insurance Details*

Policy Provider (*required)

Policy Number (*required)

Insurance quote

Please quote me for insurance

Emergency Contact

Emergency same as traveller 1

Same As Traveller 1

Emergency Contact Name (*required)

Emergency Contact Phone Number (*required)

GALAPAGOS CRUISE TRAVEL CENTRE BOOKING FORM

DETAILS OF TRAVELLERS (PLEASE ENSURE THAT YOUR DETAILS MATCH YOUR PASSPORT)

BOOKING FORM TRAVELLER 1 DETAILS

BOOKING FORM TRAVELLER 2 DETAILS

BOOKING FORM TRAVELLER 3 DETAILS

BOOKING FORM TRAVELLER 4 DETAILS

CONTACT US

BOOKING WITH US

KEEP IN TOUCH

BEYOND GALAPAGOS ISLANDS WITH TAILOR-MADE JOURNEYS