Safari Booking Form

Registrant Details

Couples residing at the same address should fill out only one registration form.
Each participant must fill out and submit a separate signed Assumption of Risk and Liability Release Agreement (Step 2, "Terms").

Gender Male Female

Second Person (if needed) First Last

Second Person Gender Male Female

Telephone

Alt. Telephone

E-mail

Address

Contact Method

How do you prefer to be contacted? (Choose one) Phone Email Mail

Emergency Contact Details

Name First Last

Relationship

Telephone

Your Preferences

Rooming Preferences (Choose one of the following)

I want a single room where available. (A single occupancy supplement will be assessed.)

I want to share a room. If roommate is unavailable, a single occupancy supplement will be assessed.

I plan to share a room with:

Smoking (Choose one of the following) I do not smoke. I smoke.

Do you have any disability or illness (e.g. walking difficulties, diabetes, asthma, angina, etc.)
at might restrict your full involvement in any aspect of the tour? No Yes

If yes, please explain:

If you have other special requirements (e.g. dietary restrictions), please advise us and we'll do our best to accommodate you: