MelbourneUniversity Alpine Lodge is dorm room style accommodation and I acknowledge that my booking may be split across multiple rooms(Please tick)

Title: ___MrMissMsMrsDrProf / Surname: / Given Names:
Address:
Number / Street / Road / Suburb / Postcode / ______ACTNSWNTQLDSATASVICWA
State
Phone: / Mobile: / E-Mail:
How did you find out about the Alpine Lodge:

"MUS is committed to observing the requirements of the Information Privacy Act. Wecollect your information for the purpose of providingyou access toour sporting facilities and services, and it is alsoretained for the development of a sports alumni at the University of Melbourne. By completing this form you consent to MUS using your information for these purposes. You can also contact MUS for a copy of theMUS Privacy Policy, or obtaina copy from

BOOKING DETAILS

All Current Fitness Memberships will need to be presented at time of booking Payment

(a) Total guests /

Nights of stay

(ie. Dates you need accommodation) / (b)Total number of nights / (c) Total bed nights
= (a) x (b) / (d) Rate per night /

Amount Payable

= (c) x (d)

Example

/ 2Members / DD/MM toDD/MM / 2 / 2 x 2 = 4 / $85.00 / 4 x $85.00 = $340
Members / /to/ / x= / $ / x $ = $
Non Members / /to/ / x= / $ / x $ = $

During the peak season Friday and Saturday must be booked together – not available as individual nights

You will need to present your Fitness Membership Card or student card to the Lodge Supervisor on arrival. Guests will need to present some form of ID to Lodge supervisor.

Please complete details below for all guests included in your booking. (If there are more than 6 guests please complete another booking form and attach)

Name / Fitness Membership/ Student
Number (if applicable) / Contact phone number
1.
2.
3.
4.
5.
6.

Fax: (03) 8344 5583MAIL:Bookings, MUS, University of Melbourne 3010

Tick Payment option: Money Order Credit Card Bankcard MasterCard Visa
Credit Card Details:  
MM / YY
Card Number - - - Expiry Date /
Signature: ______Date: /
I agree for my credit card to be used for payment and agree to the conditions of use on Information and conditions of use for Mt Buller Alpine Lodge (Please tick)

PLEASE ACKNOWLEDGE

I(Please print name)apply for a booking at the MelbourneUniversity Alpine Lodge and agree to the conditions of use on Information and conditions of use for Mt Buller Alpine Lodge. I accept it is my responsibility to ensure all guests abide by the rules and regulations herein stated and will act as the primary contact for any arising issues relating to myself and all guests.

OFFICE USE

Sale IDNo ______BookingID Number ______Confirmation letter/ email sent______Staff Member ______Date___/___/____