Page 49

Date: DD / MM / YYYY

kg

APPLICANT TWO

kg

Heritage Expeditions (2018) Ltd Antarctic House, 53b Montreal St, PO Box 7218, Christchurch, New Zealand, 8240 Tel: ++64 3 365 3500 - Fax: ++64 3 365 1300 info@heritage-expeditions.com - www.heritage-expeditions.com

Voyage Name:

EXPEDITION DETAILS

Departure Date: DD / MM / YYYY

RUSSIAN EMBARKATION (please circle): Nome Anadyr

APPLICANT ONE

(Please indicate your embarkation preference for #1924, 1926, 1928, 1930, 1934, 2005, 2007, 2009, 2011, 2025, 2029, 2031)

Body weight (Nome only):

Cabin Category:

Any other requests:

Where did you hear about us?

A 25% DEPOSIT IS REQUIRED TO CONFIRM YOUR BOOKING

PAYMENT

CONTACT US FOR NZD & AUD PAYMENT OPTIONS

Mastercard

from my credit card today

CSV Numbers: (last 3 numbers on the back of card)

Visa

BY USD TELEGRAPHIC TRANSFER For telegraphic transfers - deposits to: Account Name: Heritage Expeditions (2018) Ltd United States dollar account Account details: Bank of New Zealand International Branch, Willis Street, Wellington, New Zealand Account number: 1000 725853 0000 Swift Code: BKNZNZ22 NOTE: Please use surname and voyage number as reference.

BY CREDIT CARD -

Please debit USD

Card Number:

Expiry Date: MM / YYYY

Cardholders Name:

Signature:

"

BOOKING FORM

APPLICANT TWO (details as shown in passport)

PERSONAL DETAILS

APPLICANT ONE (details as shown in passport) Preferred Name:

PERSONAL DETAILS

Preferred Name: (as per passport)

First Names: Surname:

(as per passport)

Surname: Email:

Tel (Home):

Date of Birth: DD / MM / YYYY

First Names:

Email:

Tel (Home):

M

Tel (Work):

Sex:

Signed:

Please ensure that you sign the booking form. This indicates that you have read the booking conditions, essential information and booking your trip information and agree to abide by them and also, having read the information provided understand what is involved in the voyage. If there are minors in your party, you should sign the booking form for them and this indicates that you are taking responsibility for them.

Dietary requirements:

(or previous occupation if retired)

Occupation:

I have attached a clear copy of my valid passport.

Place & Country of Birth:

F

Postal Address (if different):

Physical Address:

Postal Address (if different):

Physical Address:

Date of Birth: DD / MM / YYYY

Tel (Work):

F

Tel (Mobile):

M

Tel (Mobile): Sex: Place & Country of Birth: I have attached a clear copy of my valid passport. (or previous occupation if retired)

Occupation: Dietary requirements:

Date: DD / MM / YYYY

Please ensure that you sign the booking form. This indicates that you have read the booking conditions, essential information and booking your trip information and agree to abide by them and also, having read the information provided understand what is involved in the voyage. If there are minors in your party, you should sign the booking form for them and this indicates that you are taking responsibility for them.

Signed:

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Heritage Expeditions 2019-20 Expedition Cruising Brochure  

Explore Antarctica, the Subantarctic, South Pacific and Russian Far East with wildlife adventure company Heritage Expeditions. Travel aboard...

Heritage Expeditions 2019-20 Expedition Cruising Brochure  

Explore Antarctica, the Subantarctic, South Pacific and Russian Far East with wildlife adventure company Heritage Expeditions. Travel aboard...