Booking request form

	Tour details
Tour selected (*)	Freycinet PaddleHobart Paddle4 day epeditionFreycinet in a day Invalid Input
Tour date	Invalid Input
Tour time	Invalid Input
Number of people	Invalid Input
	Your details
Full name (*)	Please enter your full name
Address
City
State
Postcode	is not a number.
Phone/Mobile (*)	Please add a value for .
Email (*)	is not a valid e-mail address.
Fax
Date of birth
For contact purposes only, please list your accommodation/contact details for the night prior to your tour
	For your comfort and safety please complete the following details: (this information will be kept confidential)
Can you swim?	yesno
Expected life-jacket size?	smallmediumlargeXlargeXXlarge
Do you have any medical conditions that may potentially require treatment (including any joint problems)?	Heart conditions Pregnancy Asthma Allergic reactions Blood pressure Epilepsy
Other medical condition	Invalid Input
Please list any medications you are currently taking	Invalid Input
Do you have any special dietary requirements or food allergies?	Invalid Input
	Other requirements The following items are available for purchase to make your trip more enjoyable - please indicate the amount of each item you wish to purchase. A range of Tshirts are also available for purchase at our office.
Hats - $15	Invalid Input
Drinking water - $2.50	Invalid Input
Waterproof Disposable Camera $15	Invalid Input
Package (one of each item) $30	Invalid Input
Where did you first hear about these tours?	Invalid Input
Would you like to receive information on special deals and new tours from Freycinet Adventures?	yesno Invalid Input
	Your acceptance
I have read the Booking Terms and Conditions and Acceptance of Risk and accept them (*)	yes Invalid Input