Travellers Club

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Your Details
Full Name*:
Address:
E-mail Address*:
Phone Number*:
Fax Number:
Concessions
Do you have a concession card?	Yes No
If Yes please select one from the list:
If Other please specify:
Card Number:
Tour Details
Put Your Chosen Tours Here
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Departure Date (dd/mm/yy)
Number of Adults
Number of Concessions
Number of Children (Under 12)
Dietary Requirements:	Standard Vegetarian Other…
If Other please specify:
Please specify any health concerns:
Pickup From:	Central Pickup Hotel or Hostel
If Hotel or Hostel please specify:
Payment Details
Credit Card Type:*
Credit Card Number:*	- - -
Name on Card:*
Expiry Date:* (mm/yy)	/
3 Digit CCV Number on reverse (Credit cards only):	View Example
Amount:*	All payments in Australian Dollars
I agree to the Terms and Conditions*	to Terms and Conditions
This booking form is sent via a secure server 128 bit encryption

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Booking and Payment Form Active Safaris, Travellers Club This booking form is sent via a secure server 128 bit encryption Every effort has been made to protect your details, when you send us a booking we use 256 bit encryption technology which is one of the most secure ways of transferring sensitive information over the Internet.
Pricing: All Pricing is in Australian Dollars and we accept Visa, Master Card and Bank Transfers.