Personal Particulars Form

Things we need to know about you...
When we take you on tour there is some important personal information that we also need to know such as your hotel where we are picking you up from, emergency contact details and medical/diet information. We need this information about 8 weeks before tour, or when your final account is due. Please provide this information by completing this ‘Personal Particulars’ form. All personal information will be treated ‘in confidence’.

Personal Particulars Form

What Exploranges Tour have you booked

Name

First Name

Last Name

Male

Female

Date of Birth

YYYY

Walking Clubs / Group

Travel Insurance Company & Policy Number

Ambulance Cover

Ambulance cover is compulsory as a minimum requirement. Please make sure it covers the state/ territory you are traveling to and should include the flying doctor.

Yes

Emergency Contact Name

First Name

Last Name

Emergency Contact Phone

(###)

###

####

Pre-existing Medical Conditions

Medications you are currently taking

Allergies

Any foodstuffs you cannot or will not eat

Address of pre-tour accommodation

Any Additional Important Information

If there is anything that you would prefer to talk to us about then please call Ian on 0429 991 779 to discuss.