TOUR REGISTRATION FORM

Complete in full and return with your deposit confirmation to: Fax: 086 635 1738 NOTE: Don’t wait for your passport to arrive before you sent in your registration form. You need to send in your completed registration form and deposit of R3, 000 to reserve your seat. You can fax through a copy of your passport when it arrives.

Full Names as per passport
Surname
Nick Name
Gender
Date of Birth: / MM / DD YYYY
Place of Birth:
Passport Number
Country Of Issue
Issue Date / MM / DD YYYY
Expiry Date / MM / DD YYYY
Profession:
Drop Down
Name & Tel No. of next of kin
Email
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Mobile Phone
Home Phone
Tour Reference
Tour Date Departure / MM / DD YYYY
Tour Date Return / MM / DD YYYY
Room Type Single Room Double Room - Sharing Partner Double Room - Sharing
Please note that should you share a room with another accompanied tour member, please use Double Room Sharing.
I confirm having read and accepted the Notice to Participants on tour Conditions I agree