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TITLE (MR, MRS, MS, DR, OTHER) |
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FULL NAME |
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EMAIL ADDRESS |
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| CONTACT ADDRESS |
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COUNTRY |
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DAYTIME TELEPHONE NUMBER |
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EVENING TELEPHONE NUMBER |
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| NUMBER OF ADULTS (OVER 16) |
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| NUMBER OF CHILDREN |
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| AGES OF CHILDREN, IF APPLICABLE |
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| HAVE YOU BEEN TO SUB-SAHARAN AFRICA BEFORE? |
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| If "YES", which areas did you visit before? |
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| WHICH AREAS WOULD YOU LIKE TO VISIT? |
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| PLEASE ELABORATE (INFORMATION ON PARTICULAR PLACES YOU WOULD LIKE TO VISIT OR ACTIVITIES YOU WOULD LIKE TO INCLUDE) |
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| START DATE OF TRIP (DD/MM/YY) |
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| END DATE OF TRIP (DD/MM/YY) |
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FLIGHT ENQUIRY PREFERRED DEPARTURE AIRPORT (UK ONLY) |
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PREFERRED ARRIVAL DESTINATION IN AFRICA |
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PREFERRED DEPARTURE DESTINATION IN AFRICA |
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| TYPE OF ACCOMMODATION PREFERRED |
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| ROOM TYPE |
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MOUNTAIN TREKS (Kilimanjaro, Mt Meru, Mt Kenya, Mulanje) |
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BEACH (Zanzibar, Pemba, Mafia, Swahili Coast, Mombasa, Malindi, Mozambique) |
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| WHAT ACTIVITIES WOULD YOU LIKE TO INCLUDE IN YOUR HOLIDAY? |
KILIMANJARO TREK
GORILLA TREK
CHIMP TREK
WALKING SAFARI
BOAT SAFARI
BALLOON SAFARI
CULTURAL VISIT
BEACH HOLIDAY
OTHER (PLEASE SPECIFY) |
| PLEASE PROVIDE ANY SPECIFIC INFORMATION SO WE HAVE A BETTER IDEA OF YOUR INTERESTS, PREFERRED DESTINATIONS, ACCOMMODATION OR ACTIVITY PREFERENCES, AND CAN THEN SUGGEST AN APPROPRIATE PROGRAM |
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| WHERE DID YOU HEAR ABOUT US? |
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