First Name
Last Name
Title
No. of Adults
Children
Hotel To Stay
Street Address
Address (cont.)
City
Country
Cell Phone
FAX
E-mail
Arrival Date
Departure Date
Arrival Time
You are Booking	5 Days Samburu and Maasai Mara

             Arrival Airport      Please Select One Jomo Kenyatta Aiport- Nairobi Moil Airport- Mombasa   Transfer Required Please Select one YES NO                                  

            Please select the safari lodge/camp and mode of transport of your choice from the drop-            down lists below.

            Lodges/Camps  Please select one Samburu Serena and Mara Intrepids Samburu serena and Mara serena Samburu Lodge and Keekorok Lodge Larsens Camp and Governors camp

 Other Lodges; Please specify          

            Amboseli Extension Required? Please Select One Yes No

   Please Enter the Date of your Safari  1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Day January February March April May June July August September October November December Month 2006 2007 2008 Year

             Additional Requests (Please Provide Full Names of the Party)