Surf City Connxtions Booking Form

To confirm your place on your trip, print out this form, fill in the details and post with your deposit to Surf City, 10 Maitland Street, Norah Head N.S.W Australia 2263. Completion and signing of the Reservation Form will be taken as an understanding by Surf City Connxtions that the tour participant has read and agrees to abide by these terms and conditions.

Telephone: +61 2 4396 4876 .........Mobile: +61 19 175 331......... FAX: +61 2 4396 6062

Release and Responsibility Traveling to remote areas and undertaking adventure activity as such as surfing and diving, arranged under the auspices of Surf City Connxtions entails certain risks and dangers. These may include, but are not limited to the hazards of traveling, accident or illness in remote places without medical facilities, the forces of nature and travel by air, boat, automobile or any other conveyance. In consideration of and as part payment for the right to participate in such trips and the services and food arranged for me by Surf City Connxtions and its agents or associates, I have and do hereby assume all of the above risks and will hold them harmless from any and all liability actions, causes of action, debts, claims and demands of every kind and nature whatsoever which I now have or which may arise of or in connection with my trip or participation in any other activities arranged for me by Surf City Connxtions and its agents and associates. This release does not extend to discharging Surf City Connxtions from its warranty to render services as a tour promoter with all due care and skill. The terms hereof shall serve as a release and assumption of risks for my heirs, executors and administrators and for all members of my family including any minors accompanying me. I hereby acknowledge prior to completing this booking form, having received the Surf City Connxtions General Information and Conditions Form and having read and agreed to the Responsibility and Reservation Conditions, especially noting the company's policy on cancellation and refund as authority states under 'Cancellation Fees' Surf City Connxtions are hereby irrevocably authorised to deduct from any monies paid hereunder any cancellation fees, in accordance with these conditions, which may apply in the event of me/us canceling and withdrawing from this tour.

Address:.......................................................................................................................................

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Telephone: ......................(Home)......................................(work).................................................

Emergency Contact: ....................................................................................................................

Total Cost is $US 2,500

Non-refundable deposit is enclosed (US$500 per person) $......................

Tour Name:............................................... Departure Date:.........................................

Payments can be made to Commonwealth Bank of Australia, Toukley NSW

Account Number: 062608 10087401

Please send these details to us by FAX 0011 02 4396 6062 to ensure your reservation

Acknowledgment of Conditions of Release, Responsibility & Authority.

All applicants must sign.

Signature:.....................................Date:................. Signature:........................................................Date:.................

Signature:.....................................Date:................. Signature:........................................................Date:.................