ON-LINE BOOKING

Personal Details
Title*:
 
First Name*:
Last Name*:
Address:
City:
State:
Post Code:
Country*:
Phone*:
Fax:
Email*:

Departure & Tour Dates
Tour*:
Preferred Date of Departure*:
Number of Persons Travelling*:
Adult / Children / Age(s):
Dietary Requirements:
Members of party:
Other Dietary Requirments / Party Members:
Party Fitness Level*:   Low   Medium   High
Any Additional Touring Interests:
Preferred Accommodation*:
Camping   Accommodated   Both
Other Comments / Requirements:
How Did You Hear About This Tour?*:
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Name of Publication / Search Engine:

Credit Card Payment Details (Option I)
Credit Card Type*:   Visa   Mastercard  
Card Holder Name*:
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Expiration Date*:

Non Credit Card Payment Details (Option II)
Payment (AUD$)*:   Cheque   Money Order  

I understand that by ticking this box I am acting for myself and for everyone in my party in acknowledging that Diverse Travel Australia's Terms & Conditions have been read and accepted.

Diverse Travel Australia: Terms & Conditions Click here for Terms & Conditions...

   
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Diverse Travel Australia
Adelaide University Research Precinct 35-37 Stirling Street Thebarton South Australia 5031
Telephone 61 8 8303 3418 Facsimile 61 8 8303 4363 e-mail info@diversetravel.com.au
In the USA e-mail DiverseTravelUSA@Prodigy.net