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NZ Top-2-Bottom
North Is Top-2-Bottom
South Is Top-2-Bottom
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Middle Earth Family Adventure - Application Form
Your Details:
Departure Date
21 Devember 2003
Full Name
Nickname
Full Mailing Address
T-Shirt Size
Small
Medium
Large
X Large
Day Phone
Evening Phone
Email
Fax
Occupation
Citizenship
Date of Birth
Marital Status
Height
inches
cm
Weight
lbs
kg
Gender
Male
Female
Passport Number
I'm willing to share
a room with...
Please indicate name/s and room type, ie "Double" (1 room, 1 bed), "Twin" (1 room, 2 beds) or "Triple" (1 room, 3 beds)
I Prefer single room
(supplemental cost of $400)
Describe your health and list any dietary restrictions, allergies, etc.
Describe nature and extent of your hiking and outdoor experience.
Contact Person in Case of Emergency
Traveling Companion Details:
Name
Nickname
Full Mailing Address
T-Shirt Size
Small
Medium
Large
X Large
Day Phone
Evening Phone
Email
Fax
Occupation
Citizenship
Date of Birth
Marital Status
Height
inches
cm
Weight
lbs
kg
Gender
Male
Female
Passport Number
I'm willing to share
a room with...
Please indicate name/s and room type, ie "Double" (1 room, 1 bed), "Twin" (1 room, 2 beds) or "Triple" (1 room, 3 beds)
I Prefer single room
(supplemental cost of $400)
Describe your health and list any dietary restrictions, allergies, etc.
Describe nature and extent of your hiking and outdoor experience.
Contact Person in Case of Emergency
Payment Details
Price/ Person
Number of People
Total
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Total :$
Payment Method:
Payment Method
Credit Card
Cheque
If paying by cheque, Please supply details of cheque and when sent.
If paying by Credit Card, you will NOT be debited immediately.
What's next?
We will call or email you within 24 hours (unless it's the weekend) to confirm that there's space available on your preferred trip. Once your spot is confirmed, your deposit will be processed and we'll also give you some trip paperwork to complete.