PERSONAL:
Family name:*
First name:*
E-mail:
Address:*
Zip code and place/country:*
Telephone:*
Mobile:*
Date of birth:*
Place of birth:
Nasjonalitet:*
Passport no.:
Next of kin (who will not be on board)
Family name:*
First name:*
Address:*
Zip code and place/country:*
Telephone:*
Mobile:*
E-mail:
SAILING CRUISE:
Tokt CRUISE 1: Bergen - Torshavn - Bergen 8th May - 15th May
 CRUISE 2: Bergen - Lerwick - Bergen 21st May - 25th May
 CRUISE 3: Bergen - Hardanger 20th June - 23rd June
 CRUISE 4: Bergen - Antwerpen 5th July - 10th July
 CRUISE 5: Antwerpen - Aalborg 13th July - 21st July
 CRUISE 6: Aalborg - Bergen 24th July - 27th July
STATEMENT OF HEALTH:
I do hereby declare that I am of good health*
DISEASE:
 Heart disease
 Diabetes
 Lung disease
 Epilepsy
Other disease (specify):
I have allergies/special dietary needs:
I take medication: (specify)
MEDICAL CERTIFICATE
Trainees over 70 years of age have to bring a declaration from their doctor stating that they are in good health and fi t to participate.
Special remarks:
PAYMENT
A deposit of NOK 1.000,- / EUR 125,- will be invoiced when your booking is received, or you can pay the deposit directly by credit card. The balance will be invoiced you, and is due for payment no later than 30 days before departure. Special priced cruises will be invoiced with the total amount when your booking is received.
CANCELLATION TERMS
Cancellation more than 30 days before departure: NOK 1000 / EUR 125, Cancellation 30 – 15 days before departure: NOK 1500 / EUR 188, Cancellation 14 – 7 days before departure: 50 % of total price, Cancellation less than 7 days before departure: Total price
TRAVELLING- / CANCELLATION INSURANCE
You do have to take out your own travelling insurance. To prevent loss due to illness you can buy cancellation insurance along with your regular travelling insurance. If you have to cancel due to illness, you do pay our invoice and then claim refund from your insurance company. Remember to keep the doctor’s certificate. If you pay the cruise with a credit card, you are in some occasions already insured. Check this out with your own card company.
CHOISE OF LAW AND VENUE
Any dispute arising out of this contract shall be referred to Bergen District Court and be settled in accordance with Norwegian Law. The carrier is only liable for damage or injury which is caused by the negligence of the Master, crew or other persons for which the carrier is vicariously liable. The carrier’s liability for death or injury is limited to SDR (Special Drawing Right) 175.000 for each passenger who dies or becomes injured. The carrier is not liable for any loss resulting from the vessel being delayed.
I have read and understood the information stated above.*
This order is binding.
Should you wish to cancel, it must be in writing to our office.
METHOD OF PAYMENT
Method of payment I wish to pay deposit of kr.1000,- now, the balance will be invoiced later
 I wish to have an invoice on both the deposit and the balance (+ invoice fee of NOK 35,-)

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Statsraad Lehmkuhl  |  Skur 7 Bradbenken 2  |  NO- 5003  |  Telephone: 55 30 17 00  |  Fax: 55 30 17 01  |  E-mail: lehmkuhl@lehmkuhl.no

Opening hours Skur 7: Man-fre 08.30 - 16.00  |  Photo: Statsraad Lehmkuhl - Lümmen - Grün