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Bibbulmun and Beyond Tour Registration
Bibbulmun and Beyond Tour Registration
Bibbulmun & Beyond Tour Registration
Your Details
Your Name
(Required)
First Name
Last Name
Preferred Name (if applicable)
Age at time of Tour
(Required)
Gender
(Required)
Female
Male
Other
Your Occupation
Will you be celebrating a birthday while on tour?
Yes
No
Your Address
(Required)
Street Address
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Email
(Required)
Preferred Phone Number
(Required)
Alternate Phone Number
Special Medical/Cultural Dietary Requirements (be specific)
(Required)
Write "nil" if you have none.
Travel Insurance: Company
Travel Insurance: Policy Number
Recent Bushwalking Experience
(Required)
How did you hear about the tour?
Bibbulmun News member's magazine
Bibb Bytes (our e-news)
BTF website
Google search
Facebook
Newspaper advert
Word of mouth
Can't recall
Other:
Other
I'm travelling...
(Required)
Alone
With a Travel Partner
Only select "With a Travel partner" if you are registering and paying for them as well as yourself. Otherwise they can complete their own registration. Don't select this option if they are going to register and pay themselves. If you are registering separately but travelling together, select "Alone" and just let us know in the comment box below that you would like to share your room with them.
Room Type
(Required)
Twin share
Single room supplement (see dossier for price and T&Cs)
Comments
Travel Partner's Details
Travelling Partner's Name
(Required)
First Name
Last Name
Partner's Preferred Name (if applicable)
Relationship to travelling partner
(Required)
Partner's Age at time of Tour
(Required)
Partner's Gender
(Required)
Female
Male
Other
Partner's Occupation
Will your Partner be celebrating a birthday while on tour?
Yes
No
Does your Travel Partner reside at the same address?
(Required)
Yes
No
Partner's Address
Street Address
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Partner Preferred Phone Number
(Required)
Partner's Email
(Required)
Partner's Special Medical/Cultural Dietary Requirements (be specific)
(Required)
Write "nil" if they have none.
Partner's Travel Insurance: Company (if different)
Partner's Travel Insurance: Policy Number
Partner's Recent Bushwalking Experience
(Required)
Medical & Indemnity
Please ensure that you
forward this link
to your Travel Partner. They are required to complete their own Medical Indemnity form.
I, [insert your full name]...
(Required)
acknowledge and assume all risks associated with participating in the Bibbulmun and Beyond Tour, and will hold the Bibbulmun Track Foundation & its Board, Executive Director, employees, servants, agents & members free from all liability, causes of action, debts, claims, & demands of every kind & nature whatsoever which may arise out of, or in connection with using the Foundations facilities or equipment, or participating in this tour.
My family doctor is
Address
Tel
During the tour I am likely to be taking the following prescribed medication:
for the following ailment(s)
Do you have any medical conditions: (please specify any allergies inc those to specific food types, diabetes, epilepsy, heart conditions, etc) other than already declared above?
Have you been in hospital or suffered any significant illness or incapacity in the last five years? If yes, please give details (date, condition etc).
Emergency Contact
Contact Name
First Name
Last Name
This person cannot be someone participating on the tour.
Relationship
Tel (h)
Tel (w)
Address
I understand that the Bibbulmun & Beyond Tour is a group activity and I agree to abide by the decisions of the walk leader. If I do not participate, or if I decide to leave the group for any reason I understand that I am not liable for recompense or recoup of fees and I will hold the event organisers free from any liability which may arise from my departure from the group. To the best of my knowledge I am in good health and will be fit enough to participate in the tour. In signing this form I declare that I have read, understood and agree with the above and the booking terms and conditions as stated in the tour dossier. Also in signing this form I declare that to the best of my knowledge all I have written is true and correct.
(Required)
I agree to the the following statement.
I understand that the Bibbulmun & Beyond Tour is a group activity and I agree to abide by the decisions of the walk leader. If I do not participate, or if I decide to leave the group for any reason I understand that I am not liable for recompense or recoup of fees and I will hold the event organisers free from any liability which may arise from my departure from the group.
To the best of my knowledge I am in good health and will be fit enough to participate in the tour.
In signing this form I declare that I have read, understood and agree with the above and the booking terms and conditions as stated in the tour dossier. Also in signing this form I declare that to the best of my knowledge all I have written is true and correct.
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