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Online Booking Form

CUSTOMER INFORMATION
 
First Name * Last Name * Title : *
  (Name must be the same as on your passport)    
Phone * Email * T-Shirt Size
Address Suburb Post Code
Country Occupation Special Diet
Date Of Birth * Passport No Expiry Date
Nationality Emergency Contact Emergency Phone
Relationship    
  1. 'If under 18 years of age at date of departure your legal Guardian must complete the Declaration below'
  2. 'Your Passport must be valid for at least 6 months from date of departure'
TRIP SELECTED
Trip Category * Trip Destination *
Trip Name *
Start Date * End Date * Deposit Amount *
Other Information
(If travelling with a group include the group organisers name)
Air Ticket Requirements
Travel Insurance Requirements - Travel Insurance is Mandatory
DECLARATION

I have understood and agree to the Terms & Conditions. *

I am aware that FREELINE INDONESIAN SURF ADVENTURES tour, in addition to usual and inherent risks, has certain additional risks and dangers associated with surfing in remote areas which may include; physical exertion for which I may not be prepared; remoteness from normal medical services; evacuation difficulties if i am disabled; limited communication facilities. *

I accept all inherent risks of the proposed trip and the possibility of personal injury, death, property damages or loss resulting there from. *

In entering into this agreement I am not relying on any oral, written, or visual representations or statements by FREELINE INDONESIAN SURF ADVENTURES, its agents or staff, or any other inducement or coercion to go on the trip, hence, only of my own free will. *

I do not suffer from any illness or disability which could cause problems on the trip. *

I also state I will have adequate health and travel Insurance by the departure date. Travel insurance in MANDATORY *