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To Book A Driving Experience Course please print this page and 

mail to : The Pemberton Tramway Company, Railway Crescent,

                 Pemberton, Western Australia, 6260

LOCOMOTIVE DRIVING EXPERIENCE COURSE BOOKING FORM

 

Date _____/____/________

CONTACT DETAILS:

 

NAME IN FULL:~ ________________________________________________________________________

POSTAL ADDRESS:~ ____________________________________________________________________

____________________________________________________________________

STATE/COUNTRY:~ ______________________________________________POST CODE:~ __________

TELEPHONE NUMBER:~ _________________________________________________________________

DETAILS OF TRAINEE IF DIFFERENT FROM ABOVE:

NAME IN FULL:~ ________________________________________________________________________

POSTAL ADDRESS:~ _____________________________________________________________________

________________________________________________________________________________________

STATE/COUNTRY:~ __________________________________________ POST CODE:~ ______________

TELEPHONE NO:~ _______________________________________________________________________

AGE OF TRAINEE: (MUST BE 18 YEARS OR OVER) __________________________________________

I CONFIRM THAT THE TRAINEE APPLICANT IS IN GOOD HEALTH AND IS NOT KNOWN TO SUFFER

 FROM ANY PHYSICAL OR MENTAL CONDITION WHICH MAY RESULT IN ILLNESS, INJURY, 

 OR ACCIDENT, TO THEMSELVES OR OTHERS WHILST TAKING PART IN THIS COURSE.

 

(SIGNED)        ________________________

 

 

 

 

I WISH TO APPLY FOR:

s FULL STEAM DRIVING EXPERIENCE COURSE AT $580-00 9am

s BASIC STEAM EXPERIENCE DRIVING COURSE AT $440-00 9am or 1pm

I ENCLOSE PAYMENT IN FULL TO THE VALUE OF $___________________ BY CHEQUE,

 OR PLEASE DEBIT MY BANKCARD/MASTER CARD/VISA CARD

NO_________/____________/_____________/_____________EXPIRY DATE:_____/______

$________________________ SIGNED_____________________(CARD HOLDER)

PLEASE INDICATE FIRST AND SECOND CHOICE OF DATES: FOR COURSE

(It is advisable to check availability and to confirm booking by telephone)

1ST~_________/_________/________ 2ND_________/_________/_________

FOR FURTHER INFORMATION OR ASSISTANCE, PLEASE CONTACT THE PEMBERTON TRAMWAY Co

 

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Tel: +61 8 97761322

Email: pemtram@wn.com.au