First and Last Name:

Address:


City, State, Zip
,
Country


Email Address *(required):

Phone (business):
Phone (home):
Fax:


COUNTRIES YOU ARE INTERESTED IN VISITING

SOUTHERN AFRICA

Botswana
Namibia
South Africa
Zimbabwe

EAST AFRICA

Kenya
Tanzania

OTHER

Madagascar
Malawi
Zambia

ACTIVITIES YOU'D LIKE TO PARTICIPATE IN:

Game-viewing
Photography
Birdwatching
Hiking & foot safaris
Canoeing
White-water rafting
Culture & history
Train journeys
Ballooning
Helicopter rides
Other (please specify):

TYPE OF SAFARI PREFERRED

Independent travel
Small-group scheduled trip
Private guide & vehicle
Family safari

LEVEL OF COMFORT REQUIRED

Participation camping (budget)
Full-service camping (moderate)
3 to 4-star tented camps & lodges (moderate)
5-star hotels, lodges & permanent tented camps (deluxe)

WHEN WOULD YOU LIKE TO TRAVEL?

Approximate date of intended travel
Approximate duration of stay
Approximate size of party

HAVE YOU VISITED AFRICA BEFORE: Yes No

Countries visited:


For additional requests:

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