General Information Form | Safaris Unlimited

- Safari*
- Safari Dates*
Name*
First Last
- Nationality*
- Date of Birth*
  
  DD
  MM
  YYYY
- Sex*
  - Male
  - Female
- Address*
  Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
- Passport No*
- Email*
- Phone*
- International Flight Arrival Date*
  
  DD
  MM
  YYYY
- Airline*
- Flight No*
- Time*
  
  : HH
  
  MM
- International Flight Departure Date*
  
  DD
  MM
  YYYY
- Airline*
- Flight No*
- Time*
  
  : HH
  
  MM
- Medical Insurance Company*
- 24 Hour Telephone Number*
- Policy Name & Number*
- Next of Kin*
- Contact Number*
- Dietary / Medical Information or Conditions*
- Special Requests*
Accommodation*
- Double Bed (one bed to share)
- Twin (two beds, sharing a tent)
- Single (willing to share a twin)
- Single (not willing to share - extra charge applies)
Indemnity*
Please review our Booking Terms & Conditions and the waiver, release and assumption of risk outlined in our Indemnity Policy.
- I understand and agree to the terms outlined in the Indemnity Policy and Booking Terms & Conditions.
Confirmation*
- By submitting this form I confirm the information provided is understood and correct.