| Your Name: |
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| email address: |
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| Contact Information/best way or time to be reached: |
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| Number of people in your group: |
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| Ages of any children traveling with you |
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| Time of year/month you'd like to visit |
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| Number of days on Safari |
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| During wildlife viewing would you like to: (check all that apply) |
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| Budget (or an approximation) per person |
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| Type of accommodation preferred: (check all that apply) |
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| Special interests that appeal to you (beach, culture, boating, canoeing, hot air ballooning, mountain climbing, diving, snorkeling, visit archeological sites, village visits, local craft shopping) |
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| Are you opposed to taking any internal flights |
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| Physical condition we need to take into consideration |
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| Special celebrations - honeymoon, birthday, anniversary, etc |
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| Additional comments |
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