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APPLICATION FORM FOR TRAVEL CLUB

Please correctly answer all of the follow questions:

1) 'Kiwi' (English) Name

2) First name ( as shown in your passport )

3) Family name ( as shown in your passport )

4) New Zealand Address

5) Nationality

6) New Zealand Home Phone

7) Mobile Phone

8) E-mail

9) Passport Number

10) Male Female

11) Date of Birth:

New Zealand:

12) Where would you like to visit?

Taupo / Rotorua;

Bay of Islands;

Coromandel Penninsular;

Tauranga / Bay of Plenty;

Wellington;

Christchuch;

Dunedin;

13) Other places:

eg: Queenstown, Napier, Piha, etc

14) Which month would you like to travel ?

Australia:

15) Where would you like to visit?

Melbourne;

Sydney;

Brisbane and the Gold Coast;

16) Other places in Australia:

17) Which month would you like to travel ?

18) Would like to visit The Fijian Islands ?
Yes No

19) Do you have any questions?

Any questions:

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1) 'Kiwi' (English) Name
2) First name ( as shown in your passport )
3) Family name ( as shown in your passport )
4) New Zealand Address
5) Nationality
6) New Zealand Home Phone
7) Mobile Phone
8) E-mail
9) Passport Number
10) Male Female	11) Date of Birth:
New Zealand: 12) Where would you like to visit? Taupo / Rotorua; Bay of Islands; Coromandel Penninsular; Tauranga / Bay of Plenty; Wellington; Christchuch; Dunedin;
13) Other places: eg: Queenstown, Napier, Piha, etc
14) Which month would you like to travel ?
Australia: 15) Where would you like to visit? Melbourne; Sydney; Brisbane and the Gold Coast;
16) Other places in Australia:
17) Which month would you like to travel ?
18) Would like to visit The Fijian Islands ? Yes No
19) Do you have any questions? Any questions:

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