BOOKING FORM
Your contact details
Your name:
Home address:
Telephone number:
Email address:
Level of engagement
Countries:
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Day/month/year:
Your emergency contact
Name and relationship to you:
Address:
Telephone number:
Clients
Passenger details
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Title:
First name and initials:
Surname:
Occupation:
Nationality:
Country:
Date of birth:
Weight (kg): *
* Please note we require this information in order to calculate exact weight load on bush aircraft.
Passport
Passport number:
Passport Issue date:
Passport expiry:
Passport place of issue:
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Dietary requirements and medical conditions / disabilities
Please list any dietary requirements or food allergies:
Please state if none.
Please list any medical conditions that may affect your holiday or if you have any special requirements (e.g. allergies, pregnant, asthmatic):
Please state if none.
Other special requests:
Please state if none.
International Flights
Please list departure city, destination city, times, dates and flight numbers.

Confirm flight details later
Arrival details:
Departure details:
Travel Insurance
Confirm insurance details later
Name of Insurer:
Insurer Telephone Number:
Policy Number:
Note: Please ensure that your policy covers accident, emergency repatriation or medi-vac and also cancellation of trip.
Payment Details
Payment to be made by another party
Deposit:
Total Enclosed:
Payment Options
Wire transfer (Tick to request bank details. Please ensure you pay all bank charges of transfers).
Cheque (All cheques should be made payable to JOURNEYS BY DESIGN and marked account payee only).
American Express Card ((We will contact you for details. This card carries a 2.0% fee. All other major credit cards carry fees starting from 3%).
Your financial protection
When you buy an ATOL protected air holiday package from us, you will receive a confirmation invoice from us confirming your arrangements and your protection under our Air Travel Organisers Licence 9680. In the unlikely event of our insolvency, the CAA will ensure that you are not stranded abroad and will arrange to refund any money you have paid to us for an advance booking. For further information, visit the ATOL website www.atol.org.uk

Terms and Conditions for booking with Journeys By Design
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