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	BOOKING FORM
If you would like to make a booking for the  "5 Day Wilderness Experience"  to Tasmania, please fill in the details below to submit electronically.

* = required information
*Name/s	Title                    (if other please specify below) --Select One-- Mr Miss Mrs Ms Mr and Mrs Other
Name/s	Title                    (if other please specify below) --Select One-- Mr Miss Mrs Ms Mr and Mrs Other
*Preferred departure date: 17th November 2008 16th February 2009 16th March 2009	*Room Requirements Single Twin Double
*Would you like to book the option of the West Coast Wilderness Railway at an additional cost of $105.00 per person: Yes                  No
*Address 1 Address 2 Suburb
*City                                                 *State                           *Postcode
*Phone	Facsimile
Pensioner Card No. (if applicable)
Your E-mail
Special Requests (e.g. non-smoking, ground floor, additional rooms)
You have now completed the booking form.   To send to Groups Tasmania click on the below "Submit Form" button. Once received Groups Tasmania will process your booking request and send a confirmation back to you by the end of the next working day.   Thank you for booking with Groups Tasmania.

Contact Information
Phone:       +61 3 6331 0410 Freecall:     1800 462 827 (Australia) Facsimile:  +61 3 6331 0420 Email: info@groupstasmania.com.au	Suite 1, 63 Paterson Street PO Box 864 Launceston Tasmania 7250