KOKODA BOOKING FORM

Date of trek*

Package*

Other...

* Required infomation to submit form *

PLEASE ENSURE THE SPELLING OF YOUR NAME, IS AS PER YOUR PASSPORT OR YOU MAY INCUR A $180 NAME CHANGE FEE.

Name as per passport*

PrefixFirst NameLast Name

Please Upload a copy of passport

Browse Files

A COPY OF PASSPORT WILL BE REQUIRED PRIOR TO DEPARTURE.

Preferred Name

First NameLast Name

Gender*

MaleFemale

Date of Birth*

Date

Contact number*

Email*

example@example.com

Postal Address*

Postal Street Address for Snack Packs & T-Shirts (Please note we cannot send to PO Boxes)

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Private accommodation (single room) in Port Moresby - $450.00 for 2 nights

Yes

Hotel twin share companion

Hotel accommodation will be twin share

Room Layout *

Personal Porter - Cost $750

Yes

Your personal porter will carry your items & be with you, for your entire trek. You will be issued with a backpack for your porter in PNG. You will require your own daypack for yourself for carrying water & snacks etc.

Occupation

How did you hear about us

If other please specify

TRAVEL INSURANCE INFORMATION:

Australian Kokoda Tours will require proof of Insurance Policy, including 24 hour medical emergency contact number.

Insurance Company

24 hour Travel Emergency Contact number

Policy number

EMERGENCY CONTACT DETAILS:

Emergency contact Full name*

Relationship

Emergency Contact number*

Email*

MEDICAL INFORMATION:

Doctors Certificate: Australian Kokoda Tours requires a doctor’s certificate certifying you are capable of trekking the Kokoda Track. Please include any pre existing illness, disability or condition. (This is not needed on booking and can be done 2 weeks prior to departure)

I have obtained a Medical Certificate from my doctor stating that I am medically fit and capable of undertaking a very strenuous trek along the Kokoda Track in Papua New Guinea*

Blank Medical Clearance

Please Upload a copy of completed medical

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Do you suffer from any allergies, pre-existing illness, disability, or medical conditions? All information given is strictly confidential.*

YESNO

If yes please provide details

Please list any dietary requirements including medically diagnosed. (Doctors certificate required) All dietary requirements will incur a surcharge.

BOOKING AGREEMENT:

Places are only confirmed once deposit is paid and we receive your Booking Form, including a hard or scanned copy of your passport.

Terms and conditions*

I have read and agree to the terms and conditions

Click Below for Terms and conditions

Terms and Conditions

Australian Kokoda Tours may upload photos and video of your trek that could include your image to our Facebook page & our website. FACEBOOK: Australian Kokoda Tours WEBSITE: www.australiankokodatours.com.au Please us advise us in writting if you do not provide your consent. We are very active on FACEBOOK and INSTAGRAM- Likes us @australiankokodatours

If you are on Instagram, what is your Instagram handle (name).

T-Shirt size*

To secure my booking I agree to transfer my non refundable deposit of $1500 to Australian Kokoda Tours.*

Agree

PAYMENT OPTIONS:

1. DIRECT DEPOSIT - Use the bank details below to pay via direct deposit.

BANK DETAILS:
Bank Name: Bendigo Bank
Account Name: Australian Kokoda Tours
BSB: 633000
Account Number: 172420804

PLEASE REFERENCE YOUR NAME AND INVOICE NUMBER ON DEPOSITS

2. CREDIT OR DEBIT CARD - Access via option at the bottom of Paypal page OR Please email admin@australiankokodatours.com.au including PAYMENT DETAILS: Name on Card/Card Number/Exp/CCV/Amount

There is a 1.5% surcharge on credit cards & 3% on American Express (AMEX) transaction

Please insert names of multiple deposits:

If making multiple payments, please disregard payment section on other booking forms

3. PAYPAL - Tick the button below and the Paypal option will appear upon submitting this form (if paying via Paypal or Credit/Debit card you do not need to have a Paypal account).

PAYPAL DEPOSIT

Kokoda Deposit$1,500.00AUD

Kokoda Deposit

Quantity
Item subtotal:$0.00AUD

Total $0.00AUD

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