P. O. Box 4554 ~ Potgietersrus ~ 0600 ~ South Africa
Tel/Fax : (27) 15 453 0652
Mobile : (27) 82 968 1778
e-mail: safari.afrika@safariafrika.net
NO
If you would like to do sightseeing before of after your hunt, please specify your interests :
So that our kitchen & household staff can make your stay enjoyable, please tell us your :
NO
Do you require a low-salt, diabetic or any other special diet?
NO
Please also email a copy of the picture page of your passport to safari.afrika@safariafrika.net
Personal Details   
Surname:
First name(s):
Address(Home):
Tel No:
Fax No:
E-mail Address:
Address(Work):
Tel No:
Fax No:
E-mail Address:
Contact Numbers
Person to contact in case of an emergency:
Name
Tel No:
Address(Home):
E-mail Address:
Safari Dates & Information
Number of days:
Dates from :
to :
Number in your party :
Observers :
Children :
Animal species you wish to hunt :
Will you bring our own firearms ?
YES
Itinerary
Please give us your itinerary :
Arrival Date:
Airline & Flight Number :
Arrival Time:
Departure Date:
Airline & Flight Number :
Departure Time:
Food & Health
Food preferences:
Food allergies:
Food dislikes:
Are you a diabetic ?
YES
YES
If so, please specify:
Beverages preferences -
Spirits:
Wine:
Beer:
Juices & soft drinks:
Please tell us about your health
Allergies to insects and / or antibiotics etc.:
Special medical conditions:
Special medications you may be taking:
Blood type: