Booking Form - Maria Island Walk

Booking Form
Season: October 2014 to April 2015
Trip package includes: Transfers between Hobart and Maria Island; 3 nights twin-share accommodation; all meals and wine; two guides & park entry
fees. Backpacks, waterproof jackets, head torches, sleeping bag liners and pillow cases are provided at the office.
Trip departure date: .....................................................................
Booking 1
Booking 2
Name:............................................................................ Age: ........
Name: ........................................................................... Age: .......
Occupation: .....................................................................................
Occupation: ....................................................................................
Address: ..........................................................................................
Address: ..........................................................................................
..........................................................................................................
.........................................................................................................
..................................................................... Post Code: ..............
................................................................... Post Code: ...............
Email: ...............................................................................................
Email: .............................................................................................
Phone (mobile preferred): .. ................................................................
Phone (mobile preferred): .................................................................
Fees, payment & cancellation policy
Cost: 1st Oct - 25th Dec 2014 - $2,300/person (inc. GST) / 26th Dec 2014 – 30th April 2015 - $2,350/person (inc. GST)
To secure your booking please forward completed Booking & Responsibility Forms with a $400 per person deposit. Balance of fees due 60 days
before departure. Cancellations 42-14 days before departure incur a $400 per person fee. No refund is given for cancellations less than 14 days before
departure. We strongly recommend guests take out appropriate travel insurance
Please Note: A trip may be cancelled at short notice due to weather/sea conditions or other causes beyond our control. If such a cancellation occurs
then a full refund will be given but The Maria Island Walk Pty Ltd will not be responsible for any incidental expenses incurred (e.g. cost of flight,
accommodation, hire car etc.).
Amount paid: $...................
Electronic Transfer - BSB 037001 / Account 404663 The Maria Island Walk Pty Ltd
Please add your initials and the trip departure date as a reference e.g. John Smith on the trip 23/02/14 should use: ‘JS230214’
Cheque - payable to ‘The Maria Island Walk’ (Post to: PO Box 2054, Lower Sandy Bay, TAS, 7005)
Credit card
VISA / MASTERCARD (please circle) Card no.: ............................................................................... Expiry date: ........./.............
Name: ..................................................................
Signature: ...........................................................................
CCV: .............
Would you like us to automatically charge the balance remaining when it comes due (60 days before departure date): No / Yes
Medical information / dietary requirements / general information
1. Please inform us of any medical conditions or allergies. Guests over 70 are asked to supply a medical certificate.
……………………………………………………………………………………………………………………………………………
2. Please advise of any special dietary requirements. ……………………………………………………………………………………
3. Accommodation before the walk: ……………………………… Accommodation after the walk: …………………………………
4. Do you require a drop off at Hobart Airport (flights departing from 6.00pm)? YES / NO (Flight Time: ………….…………..…)
5. How did you first hear about The Maria Island Walk? Please specify which publication
Internet…………………………….
Word of Mouth
Magazine …………………..…………
Article……………………………..
Newspaper……………………………..…..…
Other (please advise) …………………………………………..…....
Signature: .............................................................. Date: .........................................
(parent or legal guardian must sign for all persons under 18 years)
Responsibility Form
We request you complete and return this Responsibility Form together with your Booking Form
I acknowledge and agree as follows:-
1.
Reference to “MIW” shall mean and include The Maria Island Walk Pty Ltd ACN 109 252 637 its
directors, employees, agents and licensees.
2.
Reference to “I” shall mean the person or persons who have signed this agreement.
3.
I hereby release MIW from all claims and actions that I may have any time against MIW arising for any
damages or injury or any loss damage or expense that I may suffer as a result of my participation in any trip
organised by MIW provided that the loss damage injury or expense did not arise as a direct result of the
negligence of MIW.
4.
I am aware that there are obvious dangers and risks involved in activities on trips operated by MIW some
of which involve a significant degree of risk of physical harm and I am also aware there are additional
physical risks including: physical exertion for which I may not be prepared, remoteness from normal
medical services, weather subject to sudden and unexpected change, evacuation difficulties if I am
disabled. I accept and voluntarily assume all risks (both obvious and not obvious) and the possibility of
personal injury, death, property damage and loss resulting therefrom.
5.
I agree that if I suffer injury or illness then MIW is entitled, at my cost, to arrange medical treatment and
emergency evacuation services as MIW deem essential for my safety.
6.
In providing this waiver and acknowledgement I am not relying upon any representation by MIW or upon
any inducement and I undertake the trip of my own free will.
7.
I confirm that I am over the age of 18 years. Guests under 18 years of age will require a guardian to sign
on their behalf.
8.
I have read and understood the terms and conditions of this document prior to signing it.
Name ________________________
Date _____/______/__
Signed________________________
Name ________________________
Date _____/______/__
Signed________________________
EMEGENCY CONTACT DETAILS whilst you are on the walk
Name:
________________________________________________
Relationship:
________________________________________________
Contact Phone/s:
________________________________________________