Pole Cruise 2026 Registration Form
Full Name (as per ID - Licence, Passport, Birth Cert etc)
*
First Name
Last Name
Email
*
example@example.com
Citizenship (Australian, English, American etc)
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
DOB
*
-
Day
-
Month
Year
Date
Pole Level (Estimate only)
*
Please Select
Beginner
Low Intermediate
High Intermediate
Low Advanced
High Advanced
Junior
Non Poler
Roommate #1 (if applicable) - leave blank if you need us to find you a roomie
First Name
Last Name
Roommate #2 (if applicable)
First Name
Last Name
Roommate #3 (if applicable)
First Name
Last Name
Dietary Requirements
*
Vegan
Vegetarian
Gluten Free
Dairy Free
None
Other
Other
Emergency Contact
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Terms & Conditions
*
I have read and agree to the Pole Cruise Terms and Conditions (www.eastcoastpolecruise.com.au)
I understand that in the event I need to cancel this booking I will forfeit my deposit outlined in the terms and conditions
Signature
*
Cabin Type
*
prev
next
( X )
Inside Twin Share
Full Payment option - p/p
$2,100.00 AUD
$
2,100.00
AUD
Poler
Non Poler
Inside Triple Share
Full Payment option - p/p
$1,700.00 AUD
$
1,700.00
AUD
Poler
Non Poler
Inside Quad Share
Full Payment option - p/p
$1,620.00 AUD
$
1,620.00
AUD
Poler
Non Poler
Oceanview Twin Share
Full Payment option - p/p
$1,970.00 AUD
$
1,970.00
AUD
Poler
Non Poler
Oceanview Triple Share
Full Payment option - p/p
$1,750.00 AUD
$
1,750.00
AUD
Poler
Non Poler
Balcony Twin Share
Full Payment option - p/p
$2,500.00 AUD
$
2,500.00
AUD
Poler
Non Poler
Balcony Triple Share
Full Payment option - p/p
$2,100.00 AUD
$
2,100.00
AUD
Poler
Non Poler
Payment Methods
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
Continue
Continue
Should be Empty: