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1. Contact Information:
Your Full Name (required)
Country
(required)
Telephone (required)
Email Address (required)
2. Safari Information:
adults
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15
Number of participants
(required)
children
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15
Number of Children
Children Ages (separate by comma)
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January
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December
2009
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2015
to
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31
January
February
March
April
May
June
July
August
September
October
November
December
2009
2010
2012
2013
2014
2015
Dates
(required)
- -
Yes
No
Will this be your first visit to Africa?
If you have been to Africa before which countries have you visited?
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Yes
No
Would you be interested in forming part of another group on your Safari?
7. Additional Details
- -
Yes
No
Do you require our assistance for Airline Travel?
- -
Yes
No
Do you require travel insurance?
- -
Yes
No
Do you require assistance with Visa's for Tanzania?
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Yes
No
Do you have dietary/ medical requirements?
If YES for dietary/ medical requirements, what are they (strictly private)?
- -
$1000 - $2000
$2000 - $4000
$4000 +
Approximate Budget (Excl. International Airfare) per person (total duration)
Use the space provided to mention your
Safari choice/s
and any additional comments/questions
Comments
