Reservation Form | Faraway Safaris

LAST NAME (Mr/Mrs/Ms):_________________________

FIRST NAME:___________________________________

ADDRESS:_____________________________________

______________________________________________

CITY:__________________________________________

STATE:____________ ZIP CODE:______________

COUNTRY:_____________________________________

EMAIL:________________________________________

HOME PHONE:_________________________________

WORK PHONE:_________________________________

CELL PHONE:__________________________________

NAME OF TRIP(S):______________________________

DATE OF TRIP(S):_______________________________

DESCRIBE YOUR LEVEL OF FITNESS AND

WEEKLY PHYSICAL ACTIVITIES:

______________________________________________

WHERE DID YOU HEAR ABOUT FARAWAY SAFARIS?

______________________________________________

[ ] YES, I WOULD LIKE TO RECEIVE THE FARAWAY NEWSLETTER*

*FARAWAY SAFARIS WILL NOT PROVIDE YOUR EMAIL ADDRESS TO ANY THIRD PARTY MAILING LISTS.

DO YOU HAVE ANY PARTICULAR EXPECTATIONS FOR THIS VACATION?

______________________________________________

NAME OF TRAVEL COMPANION:

___________________________________

OCCUPANCY: [ ] SINGLE [ ] DOUBLE [ ] TWIN/SHARE

SPECIAL CONSIDERATIONS: (Dietary Restrictions, Allergies, Medical Conditions):

______________________________________________

In the event of an emergency, name and phone number or fax number of a person who should be contacted:

Name:_________________________________________

Phone:__________________Fax:_________________

I understand that if my statements are not true, my reservation may be subject to adjustments or cancellation. All information provided in this reservation is accurate and current. My signature to this reservation form confirms my understanding and agreement with the terms therein.

Signature X_________________________Date________

(Signature required to confirm reservation.)