Totara Tours, Ltd.

 Enrolment Form

Please print this form, complete all information, sign and date. Mail it to the address on the form.

Alternatively, e-mail the completed form. A digital signature is required and accepted.

At the same time, please remit the required deposit.

Tour number:________________                 Starting date:__________

1^st traveler.

Name:

Male/Female:

Date of birth:

Address:

E-mail address:

Telephone:

2^nd traveler

Name:

Male/Female:

Date of birth:

Address:

E-mail address:

Telephone:

Emergency contact

Name:

relationship:

Telephone:

E-mail:

Address:

Health Information.

Please list any ailments we ought to be aware of.

Your accommodation preferences. Please tick:

• Myself and spouse require double occupancy.

• I require a single room, and accept the single supplement.

• I plan on sharing a twin room with:

• We would like to share a 2-bedroom apartment, if available, with:

Certification and agreement: By my signature below, I certify that I have read, understand and agree with all the Terms and Conditions, which are incorporated herein and made a part hereof.

1^st traveler                                                                            2^nd traveler

signed:                                                                                 signed:

date:                                                                                                     date:

We have paid $                      in total deposits.

Please sign and mail to

Totara Tours Ltd

82 Eden Street

Oamaru 9400

New Zealand

Or e-mail (with digital signature) to info@totaratours.co.nz