BOOKING FORM
Please complete all fields and tick all options where applicable to ensure the swift processing of your booking.
Send to: Madventurer, 1 Pink Lane, Newcastle upon Tyne, NE1 5DW, United Kingdom
Section 1 : Personal Details
First Name:
Surname:
Age on Departure:
Date of Birth:
Sex: Male Female
Occupation:
Section 2 : Contact Details
Correspondence Address:
Daytime Telephone Number:
Evening Telephone Number:
Mobile Number:
Email Address:
Section 3 : Medical Details
Are there any medical conditions that we should be aware of? YES / NO
Do you have any special dietary requirements or food allergies? YES / NO
If yes to the above please give details:
If yes to the above please give details:
Section 4 : Other Details
The name(s) of any travelling companion(s):
Do you intend to travel independently before/after your programme? YES / NO
How did you first hear about Madventurer (please be as specific as possible)?
Section 5 : Project and/or Adventure details (please visit our website if you need to book specific details for a Placement)
Destination:
Start date:
Duration (Weeks):
Volunteering Activities
eg Building / Teaching / Sporting Activity (please advise which) / Conservation / Medic / Care-work
Second Project / Placement (if booking a Back to Back Project):
Destination:
Start date:
Duration (Weeks):
Volunteering Activities
eg Building / Teaching / Sporting Activity (please advise which) / Conservation / Medic / Care-work
Adventure:
Trip Name:
Start date:
Duration (Days):
Any Additional Information regarding Trip booking not included above
Section 6 : Payment
Promotional code/discount (if applicable)
Please select from the following:
I enclose a cheque for £150 (Adventure only) £150 (Project only) £300 (Project and Adventure) I will pay by debit/credit card over the phone
Please write your name and address on the back of your cheque and make it payable to ‘Madventurer’. Please note that the balance must be paid at least 74 days
prior to departure. If in the unlikely event we are unable to offer you the Project or Adventure you applied for, we will return your deposit.
Section 7 : Declaration
I confirm that the information that I have provided is correct. I have read and understood all the information and the terms and conditions with regard to the booking
procedure, acceptance of risk, foreign office advice, flights and insurance recommendations, security and inconveniences that may arise in the developing world
outside of the control of Madventurer. The deposit is non-refundable in the event of my cancellation. We may require further details such as next of kin and passport
details at a later stage.
Signed :
Date:
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