Request for Information

REQUEST INFO

Identify those exciting tours, lodges which appeal to you most.
Contact our expert consultants who will discuss your itinerary with you, adding any additional components which you have selected.
Once you have decided on your holiday (or when you are happy with the tailor-made itinerary that we have prepared for you), complete the booking form below and return it to us.
We will confirm your holiday as quickly as possible although this might take a week to ten days depending on the complexity of your holiday.

* Denotes required field(s)

Personal details
Title
SurName, as in passport *
First Name(s), as in passport *
Nationality, as in passport *
Date of Birth *	(mm/dd/yy)
Place of birth
occupation
Special diet? (eg Vegeterian)
Known medical condition(s)
Are you on any special Medication
Contact Details
Address 1 *
Address 2
City *
Country *
Telephone (home) Please include country and area code
Fax
Telephone (Mobile)
Email
Passport Details
Passport Number *
Place of Issue
Date of issue	(mm/dd/yy)
Valid Till*	(mm/dd/yy)
Tour Details
Tour Name (refer to itenelaries page for details)
Tour Code (refer to itenelaries page for details)
Proposed departure date	(mm/dd/yy)
Tour Duration
If you have any special interest please specify ( eg Gorillas, wildlife, etc. separate with comas)
Type of accomodation
Room type required	Double Twin Single Other
Additional interests, notes and or Specail instructions
How did you hear about us	Friend Advertisement (state publiaction ) Travel Agent (State Agent Name Other please specify

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