Booking Request Form

(Please allow 24 hours for verification of reservation)

Ph: +61-8-8231-9295    Ph: (Oz Freecall) 1800-555-322    Fax: +61-8-8231-9598    E-mail: bookings@bluegalah.com.au    Web: www.bluegalah.com.au

Fill out form below then click Submit Form button.

CONTACT PERSON: <Family Name>
CONTACT PERSON: <FIRST Names>
TELEPHONE NO.:
EMAIL ADDRESS:
TOTAL No. OF GUESTS:
CURRENT INTERNATIONAL PASSPORT HOLDER?: <Y/N to continue>	YES ($26 nightly rate applies) NO ($30 nightly rate applies)*
NAME OF ALL TRAVELLERS and SEX (M/F):
BED OR ROOM TYPE NEEDED:	SHARED Dorm Bed ($26 p/n) (Have Passport) SHARED Dorm Bed ($30 p/n) (No Passport*) SINGLE Room (1 pax PRIVATE) ($70 p/n) TWIN Room (2 pax PRIVATE) ($70 p/n) DOUBLE Room (Double Bed PRIVATE) ($70 p/n) GROUP (3 pax+) (Please call me back!)
ARRIVAL DATE: <DD-MMM-YYYY>
MIN. No. OF NIGHTS' STAY:
ENTITLED TO ANY DISCOUNT/SPECIAL? Check our Specials! (Conditions apply):	Discount Card/Voucher (VIP / YHA) International Student Studying in Adelaide Promotional Deal/Special (Declare on arrival) Other (DOM / ISIC / STA etc.)
NEED MORE INFO? (FreeCall in Oz 1800-555-322): or click button	Please call me back. I have some questions!
LEGAL DISCLAIMER <Must tick to complete booking>:	I have read and accept the House Rules / Terms & Conditions.

free forms