Small World Journeys booking form

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+61 7 4053 2878

white water Rafting under waterfall Cairns

Booking Form

Personal Information:

Trip Date:
Group or Trip Name:	(if applicable)

First Name*:	Please enter your first name
Last Name*:	Please enter your last name.
Street Address*:	Please enter your addressA value is required.
City*:	Please enter your home city/ suburb.
State: Enter your State or State code. Postcode: Enter your Postcode.Please enter your Postcode.Exceeded maximum number of characters.
Home Phone	Invalid format.
Work Phone:
Mobile:
Email*:	Please enter a valid email addressInvalid format.
Birth Date*:	Please select an item.
Nationality*:
Occupation:
How did you hear about us?

Emergency Contact

Name of emergency contact:

Ph number: Alternate ph number:

Relationship:

Medical info:

I am a: Smoker Non-Smoker

Dietary Restrictions:
Vegetarian
No Red Meat
Gluten Free
Allergic to Nuts

Other Dietary:

Describe any medical conditions you have*:
Please type NONE if you have NO medical conditions

Exercise routine/ fitness level:

Describe any medications you are taking*:
Please type NONE if you do not take any medications
Please make a selection.

Accommodation I am travelling alone
I am travelling alone, but please assign me a roommate
I am travelling alone and I prefer the single supplement if available
I will share a room with and we prefer:

Single beds A queen bed A triple

At The Great Barrier Reef

I prefer to snorkel .
I am a certified SCUBA diver. Please include the dive package on my invoice.
I am not a certified diver, but I want to try an Intro Dive/s.
I am unsure about diving at this point
I will not be going to the Great Barrier Reef.

Insurance, Terms & Conditions, Liability Release

I/We plan to obtain travel insurance from World Nomads.
I/We plan to obtain insurance from another provider.
I/We have been offered travel insurance, but do not intend to purchase it.

Please make a selection.

I confirm that I am 18 years or older and have read, understood and agree to Small World Journeys' Terms and Conditions.

I confirm I am the parent or legal guardian of a child who is under 18 years old who is travelling with Small World Journeys. I confirm that I am 18 years or older and have read, understood and agree to Small World Journeys' Terms and Conditions.

By ticking here, I affirm that I have read and understood the matters set out in the Waiver, Release and Indemnity Form and affirm that I am over the age of 18 and legally competent to give this waiver, release and indemnity. I understand that this document is contractual in nature, has legal effect and is not merely a warning nor provided for information purposes. I have read and understood this document of my own free will and without any representation or inducement by Small World Journeys, its agents or employees.

Please tick the box after you have read and agree to the above statements.

Fight Details (If known)

Arrival		Departure
Arrival Date:		Departure Date:
Airline:		Airline:
Flight #:		Flight #:
Time:		Time:

Enter Security Code:

If you are not taken to another page, please check all form fields are filled out correctly

Booking Form

Arrival

Departure