Antwerp
September 27 - October 5, 2026
THE DIAMOND BUYING CAPITAL OF THE WORLD
Member
Member No. Yourself
Partner
Surname
(same as passport)
Given Name(s) (same as passport)
Preferred Name
(for name badge)
Date of Birth Passport
No.
Expiry
No.
Expiry
Nationality Please forward a scanned copy of the front page of your passport which includes the photo to info@nationwidetravel.com.au Must have a minimum of 6 months validity from date of return
Mailing Address
Phone (bus) Phone (home)
Phone (mob)
Travelling With
(please indicate names of any other parties booked you wish to travel with)
Travel Requirements Special Dietary Requirements Do you have a medical condition or allergy to any medication? Accommodation Preferences
Single
Double - 1 bed
Twin - 2 Beds
Domestic Connection from
City of Departure Emergency Contact
(someone not travelling with you)
Name
Relationship
Contact Numbers
Home
Mobile
Frequent Flyer /Loyalty Program
Name
Number
Business Class
Premium Economy
ADDITIONAL EXTENSION
TRIP COSTS ARE CHARGED TO YOUR NATIONWIDE JEWELLERS ACCOUNT Airfares and accommodation are invoiced separately and charged to your account at the time of booking.Package costs will be split over a maximum of 6 months ending September 2026. Group dinners/meals will be charged at the conclusion of the trip. A Nationwide Travel flight booking fee of $50 per person applies to all international bookings.
Email form to
TRAVEL INSURANCE Is strongly recommended. Any Nationwide members not already on the group travel insurance scheme can be provided with a quote to join on request.
info@nationwidetravel.com.au
CANCELLATION FEES Tour cancellations within 3 days prior to departure may incur a fee. Flight cancellations fees are based on fare conditions of ticket booked. Variations to the standard itinerary will incur extra costs.
I have read and accept the Terms and Conditions:
Date
Signature
February 2026
Print Name