2015/16 - Antarctica Flights

Booking Form 2016-2017 Lead Passenger Title Mr Mrs Ms Miss Dr Other _______________ Surname _________________________________________________________ Given names __________________________________________________ Address ____________________________________________________________________________________ State _______ Postcode _______________ Phone (AH) (____) ________________________________________________ Mobile _________________________________________________________ Email _____________________________________________________________________________________________________________________________ Special Requests (e.g. wheelchair assistance, special meals etc.) _______________________________________________________________________________ Passenger Two Title Mr Mrs Ms Miss Dr Other _______________ Surname _________________________________________________________ Given names __________________________________________________ Address ____________________________________________________________________________________ State _______ Postcode _______________ Phone (AH) (____) ________________________________________________ Mobile _________________________________________________________ Email _____________________________________________________________________________________________________________________________ Special Requests (e.g. wheelchair assistance, special meals etc.) _______________________________________________________________________________ Passenger Three Title Mr Mrs Ms Miss Dr Other _______________ Surname _________________________________________________________ Given names __________________________________________________ Address ____________________________________________________________________________________ State _______ Postcode _______________ Phone (AH) (____) ________________________________________________ Mobile _________________________________________________________ Email _____________________________________________________________________________________________________________________________ Special Requests (e.g. wheelchair assistance, special meals etc.) _______________________________________________________________________________ Passenger Four Title Mr Mrs Ms Miss Dr Other _______________ Surname _________________________________________________________ Given names __________________________________________________ Address ____________________________________________________________________________________ State _______ Postcode _______________ Phone (AH) (____) ________________________________________________ Mobile _________________________________________________________ Email _____________________________________________________________________________________________________________________________ Special Requests (e.g. wheelchair assistance, special meals etc.) _______________________________________________________________________________ Reservation Requirements (Please note: Names provided must be as per Government approved photo identification) Acceptance of Terms & Conditions I/We agree to abide by the conditions identified in the brochure and on this form. Passenger 1 ____________________________________________________ Signature ______________________________________ Date _____________ Passenger 2 ____________________________________________________ Signature ______________________________________ Date _____________ Passenger 3 ____________________________________________________ Signature ______________________________________ Date _____________ Passenger 4 ____________________________________________________ Signature ______________________________________ Date _____________ I/We would like information and costs for connecting air travel from our home port and accommodation: Home Port _________________________________________________ Departure Date ______________________ Return Date _________________ I/We would like you to send information on travel insurance. I/We would like travel insurance included and have enclosed payment and travel insurance application form. I/We would like to reduce the impact of carbon emissions caused by my flight (cost $57.60 per person). We at Antarctica Flights are committed to the environment and to managing our operations to ensure a low carbon future. In partnership with Climate Friendly and GreenPower we have offset the effects of carbon emissions caused by our office activity (including staff flights and electricity). We encourage you to consider offsetting your share of carbon emissions from your Antarctica flight. Your $57.60 offset contribution will be used to invest in renewable energy projects through Climate Friendly (see www.climatefriendly.com for details). Date (Please tick) Departure City Departure Time Arrival Time 31 December 2016 Melbourne 17:30 06:30+1 26 January 2017 Perth 08:00 20:30 5 February 2017 Sydney 07:30 20:30 12 February 2017 Melbourne 08:00 20:30

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