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.
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.
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
*
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( X )
Inside Twin Share
Full Payment option - p/p
$
2,100.00
AUD
Poler
Non Poler
Inside Triple Share
Full Payment option - p/p
$
1,700.00
AUD
Poler
Non Poler
Inside Quad Share
Full Payment option - p/p
$
1,620.00
AUD
Poler
Non Poler
Oceanview Twin Share
Full Payment option - p/p
$
1,970.00
AUD
Poler
Non Poler
Oceanview Triple Share
Full Payment option - p/p
$
1,750.00
AUD
Poler
Non Poler
Balcony Twin Share
Full Payment option - p/p
$
2,500.00
AUD
Poler
Non Poler
Balcony Triple Share
Full Payment option - p/p
$
2,100.00
AUD
Poler
Non Poler
Payment Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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