PHONE

CELL

EMAIL:

HAVE YOU BEEN ON A SAFARI BEFORE? Yes No IN AFRICA? Yes No

IF NO, STATE WHERE

NUMBER OF PEOPLE IN YOUR PARTY HOW MANY UNDER THE AGE OF 12?

WHAT COUNTRIES HAVE YOU VISITED IN THE PAST 3 YEARS?

WOULD YOU LIKE YOUR SAFARI TO INCLUDE Kenya Tanzania Uganda
Other

IDEALLY, WOULD YOU LIKE Less than 7 days 7-10 days 10-14 days More than 14 days ARE YOU INTERESTED IN BEACHES TOO? Yes No

ARE THERE ANY PARTICULAR DESTINATIONS YOU ARE INTERESTED IN?

WHAT TIME OF THE YEAR WOULD YOU LIKE TO SAFARI? Jan- April May - Aug Sep - Dec

DO YOU HAVE SPECIFIC DATES IN MIND? Yes No IF YES PLEASE STATE THE DATES

ARE ANY IN YOUR PARTY PHYSICALLY CHALLENGED AND NEED SPECIAL ASSISTANCE? Yes No

WHAT DO YOU HOPE TO SEE OR EXPERIENCE ON THIS SAFARI?

DO YOU PREFER TO BE CONTACTED BY Phone E-mail