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Questionnaire

First +Last Name:*
Email:*
Select Your Country Code:*
Amount of travelers? - Number of Children who are under 12yrs old?:*
Preferred date (from and to) of travel MM/DD/YYYY to MM/DD/YYYY:*
Special Dietry Requirements?:*
Particular Destinations of interest: with the Preferred Hotels / Lodges:*
Type of accommodation preferred:* Budget - basic Camping
Comfortable - real beds but no private facilities
Luxury - your own private facilities, good food
5 Star - full luxury, gourmet cuisine and fine wines
Do you, or your party, have any specific requirements, or other information we should know about?:*
Methord of payment:* Bank Transfer
Credit Card
Book through my local Travel Agent
Verification No.:*
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