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BOOKING FORM (GB£ VERSION)
Please complete this booking form and return it together with a deposit of 10% of the full trip price(s), to your travel agent or direct to Dragoman.
Dragoman Overland, Camp Green, Debenham, Suffolk IP14 6LA UK. Tel: +44 (0) 1728 861133 Fax: +44 (0) 1728 861127. Email: sales@dragoman.co.uk Website: www.dragoman.com
PERSONAL DETAILS Surname (as passport) First Name (s) (as passport) Nationality (as passport) Place/Date of Birth (as passport) Occupation Special diet? (eg. vegetarian) Known medical conditions (Use separate sheet if necessary.)
1st Person
2nd Person (if applicable)
OTHER INFORMATION Can we give out your contact details to others on the same trip? Yes No Have you travelled with Dragoman before?
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/
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Yes
No
Where did you first hear of Dragoman? Friend - who? Advert - which publication? Travel Agent - which one?
Are you taking specific medication (what & why)
Other? I ENCLOSE Deposits (10% per person): Insurance premiums: £ £ £ £ £
EMERGENCY CONTACTS Name
Flights: Other:
Relationship Address TOTAL ENCLOSED:
CREDIT/CHARGE/DEBIT CARDS Please debit my credit/charge card the deposit*/final balance* (*delete as applicable) Please note final balance payments made by credit card will incur a 2% surcharge, this does not apply to payments made by debit cards (switch, delta etc.) or payments made by cheque. Amount: Card type: Visa Switch 1st Trip 2nd Trip (if applicable) Card number: Mastercard £ Amex
Telephone PASSPORT DETAILS Passport Number Place of Issue Date of Issue Valid Until TRIP DETAILS Trip Name Trip Reference (eg. INC29) Trip Price Trip Duration Starting At & On Finishing At & On / / / / / / / /
Card expiry date:
If Switch, issue no:
Tick this box if you wish to authorise us to charge any balance due automatically, 56 days before departure date (includes a 2% surcharge if applicable)
Address for all correspondence:
DRAGOMAN INSURANCE
Insurance Area
Start Date
Period Home tel: Work tel:
SECURITY & GOVERNMENT ADVICE (FOREIGN OFFICE ADVICE) Because the British Foreign Office information is constantly changing and because we travel through so many countries,it is impractical for Dragoman to tell clients of current stability in the countries we visit. However, if you are concerned about the political and security situation in any country, you should contact your own Government's travel advice department. The telephone number of the British Foreign Office Travel Advice Unit is 0870 6060290. www.fco.gov.uk MEDICAL DECLARATIONS FOR KNOWN MEDICAL CONDITIONS: If you have a known medical condition, you may need to complete a `Medical Declaration Form' before we can confirm your booking. Please ask Dragoman or your agent for the relevant form. Please also see booking condition 11i). FOR CLIENTS AGED 60 OR OVER: Please note we cannot confirm a booking for a person aged 60 or over unless we have received a completed `Questionnaire' which includes a Dragoman `Doctor's Certificate'. Please ask Dragoman or your agent for this form. DECLARATION I have read, understand and agree to the conditions of booking and insurance. I have read, understand and accept all information in this brochure, particularly with regard to acceptance of risk,security & Foreign Office advice, type of travel, likely conditions, and what is/is not included in the trip price & kitty. I agree to pay the balance not later than 8 weeks before the departure date. I am aware that the contract including all matters arising from it, is subject to English law and the exclusive jurisdiction of the English Courts.
Email: Agents Stamp:
2007
FLIGHT BOOKINGS
1st Person Signature Date
2nd Person (if applicable)
Dragoman can offer very competitive rates for flights to and from our trips. Book your flights EARLY, as space to many of our destinations is limited. Please telephone for a quote from our flight reservation desk on 01728 861133.
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