Please enable JavaScript in your browser to complete this form.123Welcome to your African Adventure! To book your adventure, please provide us with the details below. This information allows us to effectively prepare for your arrival and cater to your specific needs. LayoutPersonal Details Name *Surname *Email *Phone *Date of Birth (click on year and type)AgeSexMaleFemaleAddressAddress Line 1Address Line 2CityState / Province / RegionPostal Code--- Select country ---AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryPassport and Medical Details NationalityPassport NumberExpiry DatePlace of IssueTravel Insurance Co.Policy Number:Expiry Date:Dietary Requirements: *Allergies: *Any medical conditions we should be aware of:Emergency Contact Please provide contact details for the person we should contact in case of an emergency. Name *FirstLastPhone Number with internation dialling code *Email *Pilot Details Do you need to validate your Licence? (for non SA pilots renting SA aircraft)YesNoLayoutType of Licence:Country of IssueTotal Hours:LayoutTotal Time on C182 *Hours On: (Please name type of aircraft)Hours On: (Please name type of aircraft) Hours On: (Please name type of aircraft) Total Time on C206 *HoursHours Hours Other hours accumulated / experienceLayoutHave you had any Accidents / Incidents:YesNoPlease provide details *Instrument RatingEnglish Radio LicenceAircraft Hire LayoutWill you be hiring a plane? *YesNoPlease select an option below:Yes, sharing with another pilotYes, I would like to go soloYes, sharing with non-pilot family/friendsYes, with a Bushpilot GuidePlease select which aircraft you preferCessna C182 (1 to2 pax, 230hp)Cessna C206 ( 4 to 5 pax, 300hp)Other, please specify belowOther aircraft request - please provide detailsThere may be a possibility for us to source an aircraft of your choice, as long as it is suitable for bush flying and this type of tour... NextNon-pilot family or friends joining you on your trip: Please complete the details below. These details allow us to ensure your guests' needs are catered for. LayoutGuest 1 Name and SurnameRelationAgeNationalityPassport NumberDietary Requirements / AllergiesAny Special Requirements / Medical ConditionsGuest 2 Name and Surname Relation AgeNationality Passport Number Dietary Requirements / Allergies Any Special Requirements / Medical ConditionsRoom ConfigurationsDouble Rooms (One Bed)Twin Rooms (Two Beds)Single Room (Carries a Single Supplement charge)Do you have more guests? *YesNoLayoutGuest 3 Name and SurnameRelation Age NationalityPassport Number Dietary Requirements / Allergies Any Special Requirements / Medical ConditionsGuest 4 Name and SurnameRelation Age Nationality Passport NumberDietary Requirements / Allergies Any Special Requirements / Medical ConditionsPreviousNextFlight Details to and from OR Tambo - Johannesburg LayoutArrival Details: Departure Details: LayoutAirline:Departing fromFlight NumberArriving OR TamboDateTimeAirline:Flight NumberDeparting OR Tambo DateTimeLayoutSpecial requirements and further comments:Terms and Conditions View our Terms and Conditions HERE *I hereby agree to the tour specific terms and conditions set out on the relevant webpage *I confirm that the above information is true to the best of my knowledgePhonePreviousSubmit2263080538
