Port Bus Tour Booking
Complete the booking form using the labels and sections from the reference PDF. All fields are optional unless clearly marked required in the source document.
Tour Details
TOUR NAME
*
DEPARTURE DATE
*
-
Month
-
Day
Year
Date
TICKET TYPE
Passenger Details
Title
*
Please Select
Mr
Mrs
Ms
Miss
Dr
Prof
Mx
Other
Name(s) (as per ID)
*
Surname
*
Address
*
Suburb
*
State
*
Postcode
*
Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Date of Birth
*
-
Month
-
Day
Year
Date
Accommodation & Preferences
Room Type
*
Please Select
Double (1xbed)
Twin (2xbeds)
Single Supplement (extra cost)
Preferred Name (for badge)
Badge Required
*
Please Select
Yes
No
Sharing / Travelling with
Pick Up Location
Health, Dietary & Mobility
Dietary Requirements
Medical Information
Can you climb stairs?
*
Please Select
Yes
No
Can you get in and out of a boat, train, or bus?
*
Please Select
Yes
No
Can you climb into a bath?
*
Please Select
Yes
No
Do you require a ground floor room?
*
Please Select
No
Preferred
Essential
Do you require a level access shower?
*
Please Select
No
Preferred
Essential
Do you require assistance to board and disembark a vehicle, aircraft or boat?
*
Please Select
Yes
No
NA
Do you require mobility assistance?
*
Please Select
Yes (please describe below)
No
Mobility Assistance Details
Emergency Contact
Emergency Contact - Full Name
*
First Name
Last Name
Emergency Contact - Relationship
*
Emergency Contact - Home No
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact - Mobile No
*
Please enter a valid phone number.
Format: (000) 000-0000.
Travel Insurance
Travel insurance - Provider No
Travel insurance - Policy No
I do not wish to take out travel insurance cover
I do not wish to take out travel insurance cover
Submit
Submit
Signed
*
Date
*
-
Month
-
Day
Year
Date
Should be Empty: