Autumn Leaves (NZ) Limited :: Camp Online Application Form

Contact Name *

Address *

Phone

Email *

Number Attending (Enter names at the bottom of this form) *

Accommodation Type *

Bunk Room

Own Accommodation (Onsite)

Day Visitor Only

Nights Staying

We are all staying every night (Tuesday to Sunday)

We are staying some nights (please explain below)

Accommodation Comments

Meals *

We are all having all meals (Tuesday Tea - Sunday Lunch)

We are not all having all meals (please explain below)

Meals Comments

Payment Type *

I wish to pay the entire amount now (we will contact you to confirm total amount)

I am paying the $50 deposit now and will pay the balance before 10th January or on arrival (note that there is an extra cost if paying after 10th January.)

Payment Method (see payment instructions below) *

Cheque

Bank Deposit

Online Credit Card

Offline Credit Card

Attendee #1 - NAME *

Attendee #1 - Age (if under 18)

Attendee #1 - Gender *

Male

Female

Attendee #2 - NAME

Attendee #2 - Age (if under 18)

Attendee #2 - Gender

Male

Female

Attendee #3 - NAME

Attendee #3 - Age (if under 18)

Attendee #3 - Gender

Male

Female

Attendee #4 - NAME

Attendee #4 - Age (if under 18)

Attendee #4 - Gender

Male

Female

Attendee #5 - NAME

Attendee #5 - Age (if under 18)

Attendee #5 - Gender

Male

Female

Attendee #6 - NAME

Attendee #6 - Age (if under 18)

Attendee #6 - Gender

Male

Female

Extra Comments

North Camp Online Application Form