Safari Afrika Reservation Form

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

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 :

Do you require a low-salt, diabetic or any other special diet?

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

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: