Holland Track Booking Form.

Please fill out the Holland Track Booking form below to sign up for this 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.

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

We do need a minimum number of vehicles booked for this trip. In the event that bookings are below the required minimum your payments will be fully reimbursed.

Tag-along on the Holland Track, Western Australia.

The Holland Track And Beyond (4 day adventure).

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*

Mobile*

DOB:*

Date of Trip:*

April 26 - 29 / 2018

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

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?*

Passenger Details:1

Name

DOB:

Passenger Details:2

Name

DOB:

Passenger Details:3

Name

DOB:

Passenger Details:4

Name:

DOB:

Any special occasions during the tour e.g. birthday or anniversary (mainly applies for overnight or longer tours).

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:*

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.

The information you are asked to provide to 4 Wheeling in Western Australia is personal information and is protected by the Privacy Act 1988. 4 Wheeling in Western Australia collects your personal information to maintain/manage your application for a Booking.

4 Wheeling in Western Australia will not disclose this information to other parties other than in accordance with the Privacy Act 1988

Leave Holland Track Booking Form And Go 4 Wheeling In Western Australia.

Go To Tag-Along.

Holland Track Booking Form.

The Holland Track And Beyond (4 day adventure).

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