PLEASE COMPLETE THE FOLLOWING FORM TO REGISTER YOUR INTEREST
Full Name:
Address:
Email:
Interests:
Diving
Fishing
Hunting
Bush walking
Photography
History
Geography
Flora and Fauna
Male or Female
Male
Female
Age Group
15-20
21-30
31-40
41-50
51-60
60+
Would like to join a trip:
Select trip date
2006 Oct 1-6
2006 Dec 3-8
Select trip date
2007 Jan 20-25
2007 April 10-15
2007 Jul 7-12
2007 Sep 12- Oct 4
2007 Dec 16-21
Number in your Group
1
2
3
4
5
6
7
8
9
10
Traveled to Fiordland before?:
Yes
No
Additional Comments: