Booking Form

Name/Code of the trip/expedition : Departure Date : Full name(s) : Sex (Male/Female) : Date / place of birth : Nationality : Passport No. : Date of expiry : Country of Residence : Private phone : Mobile phone or other : E-mail / fax : Address : Experience in previous expeditions or your last trip : Are you a vegetarian or have other special dietary needs? I have read the Terms and Conditions (http://www.antarctic-company.com/terms-and-conditions.htm) of TAC and agree to abide by them. Date ____-____-_______  Signature _________________