Information Request
Name as per passport
*
Mr.
Mrs.
Dr.
Ms
Master
Prefix
First Name
Last Name
E-mail
*
example@example.com
Mobile Number While Travelling
*
-
Country code
-
Area Code
Phone Number
Date of birth [Day/Month/Year]
*
-
Day
-
Month
Year
Date
Nationality as per passport you will use
*
As per passport you will travel with
Passport Number
*
Passport Expiry Date
*
-
Day
-
Month
Year
Date
Physical Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Your Weight
*
We need this for light aircraft flight safety, guests who weigh more than 100kg on light aircraft will need to pay for additional seating.
Your weight is in Pounds or Kilograms
*
Please Select
Pounds
Kilograms
Bed Preference
*
Please Select
Two separate beds [friends or family traveling together]
King or Queen bed for married couples/partners
Emergency Contact Person
*
Not traveling with you
Emergency Person Contact Number
*
Travel Insurance Company, Policy Number and Contact Info
*
If you don't have yet, just indicate NA. It is however essential to get this before departing, if there is an emergency, the only way a lodge or hotel can contact someone is via the details supplied on this form.
Dietary Requirements
*
None
Vegetarian
Vegan
Kosher
Gluten-free
Other
Preferred Drinks
If you do prefer specific drinks, we will do our best to source these before you arrive
Specific Interests
Like birding, photography, animals you wish to see so we can let our partners know!
Medical Information & Chronic Medicine
*
Do you have any medical conditions that we need to be aware of, or are you taking any chronic medication that we should know about?
Special Occasion?
If this is a honeymoon, anniversary or any other special occasion, please tell us what it is and what date?
By submitting this form, you are agreeing to our Terms and Conditions, viewable on our website under INFO & FAQ
*
I agree to the terms and conditions
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