Travel Information

Passport Information

First Name

Passport Number

Date of Birth

Middle Name

Issue Date

Place of Birth

Last Name

Expiration Date

Nationality

Gender

Male

Female

Frequent Flyer Number

Special Needs
(Meals, wheelchair, etc.)

Address

Address 2

City

State

Zip

Seat Preference

Aisle

Window

No Preference

Initial Departure Location
(ex. Chicago, IL - OHare Airport (ORD))

Phone (home)

Phone (mobile)

Phone (work)

Arrival Date
In Africa

Group Booking Name

Departure Date
From Africa

We strongly suggest that you discuss and take out insurance to cover the cost of your entire trip in case of cancellation and/or loss. Our travel agents can advise and arrange this for you.
Please ensure that every person in the group fill out this form individually.