Booking Enquiry Form
Submit the form below and we will reply as soon as we can to confirm your booking.
Surname
First Name
Male
Female
Age
First Name
Male
Female
Age
First Name
Male
Female
Age
First Name
Male
Female
Age
Student ID No.
Contact Name
E-mail address
Address
Phone Home
Phone Work
Ski Package: Choose one
Standard Package ( Broken River Lodge )
or Fully Serviced Option ( Lyndon Lodge )
or Self Cater Option ( White Star Chalet )
Ski Package Dates from
to
I/We would like to be accommodated with:
Group Leader Yes
No
Please indicate Number of skiers
Number of Snowboarders
How did you find out about Broken River?
Word of Mouth
Brochure
The Internet
News Paper
Snow Show
Club Member
Other (please indicate)
Juniors (under 18) not accompanied by an adult must have the signature of an adult (over 21) willing to be responsible for them.
Name of Adult
Name of Junior
Name of Junior
I agree to accept responsibility for the above named Junior/s.
