CONTACT INFORMATION: * = Required
*Your E-mail (we cannot respond without this) *Your Name
Address
City
State/Province ZIP/Postal Code
Country

Daytime telephone
Evening telephone
Fax

WHAT COUNTRIES ARE YOU INTERESTED IN VISITING?

Botswana	Kenya	Namibia	Rwanda	South Africa
Tanzania	Uganda	Zambia	Zimbabwe

Other

Unsure at this time

WHAT TYPE OF SAFARI WOULD YOU PREFER?
Private Safari (Your own guide and 4x4 throughout - Kenya & Tanzania only)
Small Group Safari (set departure dates with group size ranging from 7 to 10 maximum)
Flying Safari (Fly from camp/lodge to camp/lodge - activities are led by resident guides)
Unsure at this time
Other

ACCOMMODATIONS?
Small Luxury Lodges and Safari Camps
Comfortable Lodges and Safari Camps
Luxury Mobile Camping
Comfortable Mobile Camping

SPECIAL ACTIVITIES AND INTERESTS?

Game Drives	Guided Wildlife Walks	Night Game Drives
Cultural Encounters	Bird Watching	Hiking/Climbing
Gorilla Trekking	Chimpanzee Safaris	Mokoro Ride
Canoeing	Elephant Back Safari	Camel Ride
Horseback Riding	Luxury Trains	Golf
Beach/Coastal Visit	Other

When would you like to travel?
Number of persons traveling?
How long would you like to be on Safari?

Would you like a Safari Specialist to call you?
Yes, please call me No thanks, just email me for now.

OTHER COMMENTS OR QUESTIONS?