Booking Form - Europe
KUMUKA BOOKING REFERENCE:
Please return this completed form to your agent or to:
Kumuka Worldwide Level 4, 46-48 York Street, Sydney NSW 2000
Tel: 02 9279 0491 Fax: 02 9279 0492 E-mail: sales@kumuka.com.au
Passenger Details - PLEASE COMPLETE IN BLOCK CAPITALS AS PRINTED IN PASSPORT
MR/MRS DATE OF BIRTH DATE OF ISSUE EXPIRY DATE
MISS/MS FIRST NAME SURNAME NATIONALITY PASSPORT NUMBER DD/MM/YY PLACE OF ISSUE DD/MM/YY DD/MM/YY OCCUPATION
1) / / / / / /
2)
/ / / / / /
3) / / / / / /
4) / / / / / /
Address Details for all correspondence - PLEASE NOTIFY US IMMEDIATELY IF YOUR ADDRESS SHOULD CHANGE
HOME TEL: In an Emergency contact the following:
WORK TEL: Name:
TOWN/CITY MOBILE: Relationship:
POSTCODE
E-MAIL: Tel:
Tour details - LIST BELOW THE TOUR(S) WHICH YOU WISH TO BOOK
DEPARTURE DATE
TOUR REF TOUR NAME(S) DD/MM/YY JOINING POINT FINISHING POINT MEDICAL & DIETARY TOUR COST
/ /
$
/ /
$
Travel Insurance -
WE REQUIRE KUMUKA’S APPROVED INSURANCE
COMPULSORY FOR ALL PASSENGERS
ALTERNATIVE COVER HAS BEEN ARRANGED
Pre & Post Tour Accommodation - EXTRA HOTEL NIGHT(S)
If you plan to arrive early or would like to spend extra time at the end of your holiday and wish us to book additional nights accommodation for you, please complete this section. Wherever possible, accommodation will
be booked at the hotel which is designated as the meeting point for your tour. If you are travelling alone, extra nights accommodation must be booked on a single room basis.
NUMBER SINGLE DOUBLE TWIN
CITY DATE IN DATE OUT OF NIGHTS
PRE-TOUR / / / / ROOM TYPE-
POST-TOUR / / / / ROOM TYPE-
Payment details - CHEQUES SHOULD BE MADE PAYABLE TO KUMUKA WORLDWIDE
Please charge my Credit Card account with the following amount - DEPOSIT - AU$300 PER PERSON
$
Full Payment/Deposit
$
- NZ$400 PER PERSON
OR FULL PAYMENT
$
NAME ON THE CARD
(if within 60 days of departure)
(TICK AS APPLICABLE)
TOUR FUND (if applicable) $
MASTERCARD DELTA SOLO MAESTRO VISA AMERICAN EXPRESS
INSURANCE
CARD NUMBER
$
(Compulsory for all passengers)
EXTRA HOTEL NIGHTS
$
MAESTRO CARD ONLY VALID FROM EXPIRY DATE
ISSUE NUMBER
TOTAL COST
$
Travel Agent Stamp
Card Holder’s SIGNATURE:
I have read the booking conditions and accept them on
behalf of all members of my party by whom I am duly
authorised to make this agreement. I also agree to pay any
DATE: balance no later than 60 days before departure
.
HOW DID YOU HEAR ABOUT KUMUKA?
SIGNATURE
Date:
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