THE MILLENNIUM BUG PARTY APPLICATION FORM 
 NAME 
(FULL PASSPORT)
ADDRESS
PHONE NUMBER (H) (W) 
EMAIL  FAX
AGE 
18-20
T-SHIRT SIZE 
Small
 21-35 

Medium 

 36+ 

Large 

 Not telling 

Extra Large
 ACCOM. REQUIRED: 
GRAND BURE
LODGE
BURE 
 Twin shr $2300.00 
$2050.00 
Twin shr $2550.00		 Triple shr $2450.00  Quad shr $2350.00 
If sharing accom in a Lodge or a Bure, please provide the names of the people you wish to share with:
1 :  
3 : 
2 :  
4 : 
From where will you be departing?
  Brisbane Sydney Melbourne Other
If other, please specify
AFTER SUBMITING THIS APPLICATION VIA E-MAIL PLEASE PRINT OUT AND RETURN
THE SIGNED AGREEMENT AT THE BOTTOM OF THIS PAGE WITH A DEPOSIT OF 
$A350.00  TO: 
            "The Millennium Bug Party" 
            Attention: Dave Paddington 
            34 Sherborne Street 
            Carindale 4152 Queensland Australia 
            Mobile phone number: 0411 398 048 
            EmaiL: [email protected] 
I have read the attached Conditions of Travel and agree to them, 
 
 Signature Date