PWS AFRICA Travel Payment
Traveler's Name
*
First Name
Last Name
Email
*
example@example.com
Date of Birth
*
-
Month
-
Day
Year
Date
Phone Number
*
-
Area Code
Phone Number
Billing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Allergies?
*
If none, please put N'A
Do You Have A Passport?
*
Yes
No, Haven't Applied
No, Already Applied
T-Shirt Size
*
XS
Small
Medium
Large
X-Large
XX-Large
XXX-Large
Other
Terms and Conditions
*
Signature
*
Date
*
-
Month
-
Day
Year
Date
My Products
prev
next
( X )
Deposit
Non-Refundable Deposit is $300 per person. A monthly invoice will be emailed to you.
$
300.00
Quantity
1
2
3
4
5
6
7
8
9
10
1 Person Pay In Full
King Bed
$
3,500.00
Quantity
1
2
3
4
5
6
7
8
9
10
2 People Pay In Full
Double Beds-$2600pp
$
5,200.00
Quantity
1
2
3
4
5
6
7
8
9
10
2 People Pay In Full
King Bed-$2600pp
$
5,200.00
Quantity
1
2
3
4
5
6
7
8
9
10
Submit
Should be Empty: