Video & 4x4 Adventure Form For Booking. 

Please fill out the Video & 4x4 Adventure form below to sign up for the tour.

After you submit this form, we will contact you by E-Mail regarding payment and how you can pay.

At this stage, payment is available by EFT and PayPal only. If you are using EFT, please E-Mail us a copy as proof of payment because it can take 3-4 days before it shows up in our bank account.

To secure your place a deposit of $50.00 must be paid at  the time of your booking and the remaining amount is to be paid at the latest 30 days before departure.

There is only room for 2-3 cars on these tours so it is important we receive your deposit ASAP. First, to pay deposit is locked in on the tour.

We are only allowing 2-3 vehicles on these video trips as we have 3-4 crew
cars already on each trip.

Both tough trips are $275 each, camp fees included

Holland track $520, camp fees included

Murchison $450, camp fees not included (camp fees to be paid in person $35
per night 3 payments)

This Form cannot be submitted until the missing fields (labelled below in red) have been filled in
Video & Adventure Trips Tag Along Form.
Please note that all fields followed by an asterisk must be filled in.
First Name*
Last Name*
E-Mail Address*
Street Address*
City*
State/Prov
Country*	CountryUnited StatesCanada----------------AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntiguaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyIvory CoastJamaicaJapanJordanKazakhstanKenyaKiribadiNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoFederated States of MicronesiaMoldovaMonacoMongoliaMontserratMoroccoMontenegroMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaS. Georgia and S. Sandwich Isls.Saint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSt. HelenaSt. Pierre and MiquelonSudanSurinameSvalbardSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluU.S. Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamUS Virgin IslandsWallis and Futuna IslandsWestern SaharaYemenYugoslavia (former)ZaireZambiaZimbabwe
Mobile*
DOB:*
Additional Driver Details, these questions will help us assist you along the tour: Are you familiar with and understand your vehicles 4WD system?*
Yes No
Please select your tour.*
---Select---17-24 March 2016.
Have you been driving 4x4 Off-road before?*
Yes No
How much off-road experience would you say you have on a scale from 1 to 10, with 1 No Experience and 10 Expert?*
---Select---1 2 3 4 5 6 7 8 9 10
Passenger Details:1
---Select---Mr Mrs Miss
Name
DOB:
Passenger Details:2
---Select---Mr Mrs Miss
Name
DOB:
Passenger Details:3
---Select---Mr Mrs Miss
Name
DOB:
Passenger Details:4
---Select---Mr Mrs Miss
Name:
DOB:
Does the Driver/s or Passengers have any Medical Conditions? Please list any medical conditions here:
Vehicle Details: Make & Model*
Year:*
Type:*
Fuel Type & Fuel Capacity:*
Colour:*
No. of Cylinders:*
---Select---4 6 8
Rego No:*
Modifications and accessories on the Vehicle:
You will need a UHF radio and an Air Compressor, If you haven't got one they can be hired for $ 15 each or $ 25 for both a day.
UHF Radio $15.00 Air Compressor $15.00 UHF Radio & Air Compressor $25.00
Other Information:
Terms & Conditions*
I have read and agree to the Terms & Conditions. (See Link Terms & Conditions)
GDPR*	I am at least 16 years of age. I have read and accept the privacy policy. I understand that you will use my information to contact me or send me the information I requested.
Please enter the word that you see below.

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Leave 4x4 Adventure Form And Go 4 Wheeling In Western Australia.

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