Small Group Tour Booking Form

To book your space/s on a tour

• Complete the booking form below, or print a booking form and post or fax it to us.
• To confirm your space on a tour, a deposit is required US$400 per person (or NZ$400 per person if in New Zealand).
• Your deposit can be paid by credit card. If in New Zealand you may also to choose to pay by cheque or bank transfer.
• By booking your space on a tour you are accepting the booking conditions and liability release.

Upon receiving your booking and deposit

• We will confirm your reservation and send you a receipt, Medical Form, and comprehensive Tour Dossier.
• The Medical Form should be completed and returned to us within 30 days of registration.
• If the tour date you request is already full we will contact you immediately and offer an alternative date, alternative tour, or a full refund of your deposit.

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Tour * Select One Discover Burma tour Discover Cambodia tour Discover New Zealand Tour Discover Peru tour & Galapagos Islands Tale of the Dragon - Vietnam tour Three Points North - Southeast Asia tour

Date of Departure * Select Tour First

 

Full name as in passport

Salutation * Ms Mrs Mr Dr

First & Middle Names *

Last Name *

I like to be called

 

Postal or Mailing Address *

Country * Select One Albania Algeria American Samoa Angola Anguilla Argentina Aruba Australia Austria Bahamas Bahrain Bangladesh Barbados Belgium Belize Benin Bermuda Bolivia Botswana Brazil Brunei Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central Africa Chad Chile China Colombia Comoros Congo Cook Islands Costa Rica Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Ethiopia Falkland Islands Fiji Finland France French Polynesia Gabon Gambia Germany Ghana Gibraltar Great Britain Greece Greenland Grenada Guatemala Guinea Bissau Guinea Republic Guyana Haiti Hawaii Honduras Hong Kong Hungary Iceland India Indonesia Iran Ireland Israel Italy Jamaica Japan Jordan Kenya Kiribati Korea South Kuwait Lao Laos Latvia Lebanon Lesotho Liberia Libya Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Mariana Islands (Guam) Mauritania Mauritius Mexico Midway Island Morocco Mozambique Mynamar (Burma) Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Norway Oman Pakistan Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saudi Arabia Senegal Seychelles Sierra Leone Singapore Solomon Islands Somalia South Africa South Pacific Spain Sri Lanka St Lucia St Vincent Sudan Suriname Swaziland Sweden Switzerland Taiwan Tanzania Thailand Tibet Togo Tonga Trinidad & Tobago Turkey Turks & Caicos Islands Uganda United Arab Emirates United Kingdom United States of America Uruguay Vanuatu Venezuela Vietnam Volunteer Western Samoa Yemen Zaire Zambia Zimbabwe

Day Phone *

Evening Phone *

Cell phone

Email *

 

Passport Details (if available) I will provide my passport details after registration, with the medical form

Date of Birth * Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec Year 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Passport No.

Date of Issue Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec Year 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002

Date of Expiry Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec Year 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031

Authority

Nationality

 

Tour cost is based on twin or double share. Please select your preference: I will share a room with Double preferred  Twin preferred
I am happy to share with another group member of the same sex
I prefer a single room and will pay the single supplement fee

 

How did you hear about Pacific Discovery? * Select One Personal referral Advertisement Internet search Other

 

Select Payment Option * Credit Card
Cheque (if in New Zealand only)
Bank Transfer (if in New Zealand only)

 

I acknowledge that I have read, understand and accept the booking conditions and liability release

 

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