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Reservation Number

Title Passenger 1
Select... MR MS MRS

Name Passenger 1

Title Passenger 2
Select... MR MS MRS

Name Passenger 2

Address

City

State

Postcode

Country

Telephone

(Please fill in area code and phone number.)

Email

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Birthdate Passenger 1

Birthdate Passenger 2

Do You Wish To Join Our Free Past Passenger "Captain's Club" And Receive Discount Promotional Offers?
Yes No

Age Category Passenger 1
0-18 years 19-24 years 25-39 years 40-54 years 55-74 years 75+ years (A Doctors certificate of fitness to travel is required)

Age Category Passenger 2
0-18 years 19-24 years 25-39 years 40-54 years 55-74 years 75+ years (A Doctors certificate of fitness to travel is required)

Are You A Past Passenger / "Captain's Club" Member?
Yes No

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Cruise Duration
3 Nights 4 Nights 7 Nights

Departure Date
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 1 2 3 4 5 6 7 8 9 10 11 12 2010 2011 2012 2013 2014 2015

Number Of Passengers In Cabin

Cabin Type
Inside Cabin Outside Cabin Stateroom

Cabin Configuration (Twin Bedding Standard)
Single Upper & Lower Berths Twin Double Bed Triple Quad
(A surcharge of $50 per room per night applies to Inside and Outside Cabins with a double bed.)

Complimentary Options
Car Parking in Mannum
Transfers from the Mercure Grosvenor Hotel , 125 North Terrace , Adelaide (Bus departure is 1.30 pm)

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Special Requests / Diet / Occasion / Comments

Terms And Conditions

Please refer to the Passenger Cruise Contract.
If you are age 75 years or over please ensure you read Clause 8 of the passenger cruise contract

It is recommended that passengers take out travel insurance which specifically covers cancellation fees; most claims arise from either personnel or close-family illness before departure resulting in cancellation charges. Please consult your own insurance company or you may want to consider this Travel Insurance Company "Plan KA"

Agreement

I have read, understood, and agree to comply with all the terms and conditions presented in this booking form and through making advance payment agree to be bound by the terms and conditions of the Passenger Cruise Contract, a copy of which I have retained.

Date

Please Fill In Your Name As Signature

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