Pre Departure Information Form

Lead Passenger name:

Email:

Number of passengers:

Safari Dates:

From

To

Passenger 1 Information:

Title

Surname

First Name

Date of Birth

Nationality

Address

Passport Number

Dietary Requirements

Emergency contact name

Phone number

Flight Arrival details

Airline

Flight Number

Date

Time

Flight Departure details

Airline

Flight Number

Date

Time

Rooming Preference (put amount required in boxes)

Double

Twin

Single

I/we have read the company's Terms and Conditions (See www.volcanoessafaris.com under 'Travel Info'), including the terms on liability and cancellation and accept them on behalf of myself/ourselves and all the other persons on this booking form, by whom I/we are authorised to make this agreement

I/we will purchase adequate travel insurance cover and will provide details of this cover to Volcanoes as necessary.

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Please send me the Volcanoes Safaris Brochure