Trek West Booking Form

Booking Form
This booking form is subject to the booking conditions detailed below in the Terms and Conditions of Trek West.
Name

First NameLast Name
Email
example@example.com
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState

Postcode
Emergency Contact

First NameLast Name
Emergency Contact Relationship
Emergency Contact Phone Number

Area CodePhone Number
Group Name (eg. The Smith Group)
Booking for (hike type)
Start date at hike (Day 1 of itinerary - departing Mount Isa)

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Medical Conditions - Please specify allergies, diabetes, seizures, heart conditions etc.
Details of prescribed medication you are likely to be taking during the hike
Dietary Requirements -We can cater for most medical and allergy dietary requirements with prior notice.
Travel Insurance Details
Terms and Conditions To print and sign form please click on the pop out icon in the top right hand corner of the Terms and Conditions below.
I have read and accept the Terms and Conditions attached.
Upon receipt of this booking form and agreeing to the terms and conditions, an invoice will be sent to your nominated email address. Payment of $1000 for your deposit is to be received within 7 days from the invoice date to secure your place on the hike, the remaining amount will be due 60 days prior to your hike departure date. Please don't hesitate to contact us if you have any questions info@trekwesthiking.com.au or phone 0747484998
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