Antarctica Flights Brochure Page 9

Booking Form

2015-2016

Lead Passenger Title Mr Mrs Ms Miss Dr Other _______________
Surname _________________________________________________________ Given names __________________________________________________
Address ____________________________________________________________________________________ State _______ Postcode _______________
Phone (AH) (____) ________________________________________________ Mobile _________________________________________________________
Email _____________________________________________________________________________________________________________________________
Special Requests

(e.g. wheelchair assistance, special meals etc.)

_______________________________________________________________________________

Passenger Two Title Mr Mrs Ms Miss Dr Other _______________
Surname _________________________________________________________ Given names __________________________________________________
Address ____________________________________________________________________________________ State _______ Postcode _______________
Phone (AH) (____) ________________________________________________ Mobile _________________________________________________________
Email _____________________________________________________________________________________________________________________________
Special Requests

(e.g. wheelchair assistance, special meals etc.)

_______________________________________________________________________________

Passenger Three Title Mr Mrs Ms Miss Dr Other _______________
Surname _________________________________________________________ Given names __________________________________________________
Address ____________________________________________________________________________________ State _______ Postcode _______________
Phone (AH) (____) ________________________________________________ Mobile _________________________________________________________
Email _____________________________________________________________________________________________________________________________
Special Requests

(e.g. wheelchair assistance, special meals etc.)

_______________________________________________________________________________

Passenger Four Title Mr Mrs Ms Miss Dr Other _______________
Surname _________________________________________________________ Given names __________________________________________________
Address ____________________________________________________________________________________ State _______ Postcode _______________
Phone (AH) (____) ________________________________________________ Mobile _________________________________________________________
Email _____________________________________________________________________________________________________________________________
Special Requests

(e.g. wheelchair assistance, special meals etc.)

_______________________________________________________________________________

Reservation Requirements (Please note: Names provided must be as per Government approved photo identification)

Acceptance of Terms & Conditions

I/We agree to abide by the conditions identified in the brochure and on this form.

Passenger 1 ____________________________________________________ Signature ______________________________________ Date _____________

Passenger 2 ____________________________________________________ Signature ______________________________________ Date _____________

Passenger 3 ____________________________________________________ Signature ______________________________________ Date _____________

Passenger 4 ____________________________________________________ Signature ______________________________________ Date _____________

I/We would like information and costs for connecting air travel from our home port and accommodation:

Home Port _________________________________________________ Departure Date ______________________ Return Date _________________

I/We would like you to send information on travel insurance.

I/We would like travel insurance included and have enclosed payment and travel insurance application form.

I/We would like to reduce the impact of carbon emissions caused by my flight (cost $57.60 per person).

We at Antarctica Flights are committed to the environment and to managing our operations to ensure a low carbon future. In partnership with Climate Friendly and GreenPower we
have offset the effects of carbon emissions caused by our office activity (including staff flights and electricity). We encourage you to consider offsetting your share of carbon emissions
from your Antarctica flight. Your $57.60 offset contribution will be used to invest in renewable energy projects through Climate Friendly (see www.climatefriendly.com for details).

Date (Please tick)

Departure City

Departure Time

Arrival Time

31 December 2015

Melbourne

18:30

07:00+1

7 February 2016

Sydney

07:30

20:30

14 February 2016

Melbourne

08:00

20:30

26 January 2017

Perth

08:00

20:30