Your Full Name:

Mr. Mrs. Ms. Prof. Dr. Rev. Sheikh.

Contact Information

E-Mail:

Location:

Date of arrival to Tanzania: Day 01st 02nd 03rd 04th 05th 06th 07th 08th 09th 10th 11th 12th 13th 14th 15th 16th 17th 18th 19th 20th 21st 22nd 23rd 24th 25th 26 27th 28th 29th 30th 31st NONE Month January February March April May June July August September October November December Year 2007 2008 2009 2010

Itinerary Code

General date of arrival to Tanzania (e.g. Summer/Spring 2007" e.t.c )

Length of time in bush (Number of days)

Length of time in Zanzibar (Number of days)

Place that you want to visit in Northern Tanzania (Check all that apply)

Serengeti National Park

Ngorongoro Conservation Area

Lake Manyara National Park

Tarangire National Park

Arusha National Park

Kilimanjaro National Park (see below)

Overnight in Arusha Town

Other

Places that you want to visit in Southern Tanzania

Selous Game Reserve

Ruaha National Park

Mikumi National Park

Coastal area (south of Dar es Salaam)

Mafia Island

Overnight in Dar es Salaam

Other Places in Southern TZ

Places you want to visit in Zanzibar (check all that apply)

Stone Town (Zanzibar City)

Northeast beach resorts,

Southeast beach resorts,

Mnemba/Chumbe Islands

Pemba Island

Town Tour Excursion

Prison Island Excursion

Spice Gardens Excursion

Jozani Forest Excursion

Other

If you are interested in climbing Mt Kilimanjaro or Mt Meru, please indicate your climb preference.

5 Day Marangu Route Kilimanjaro

6 Day Marangu Route Kilimanjaro

6 Day Machame Route Kilimanjaro

7 Day Machame Route Kilimanjaro

Mount Meru

Other Mt Kili, Mt Meru routes

Interest

Wildlife

Tribal People (Maasai)

Culture

Scenery

Other

Do you want a private safari or would you prefer to join a group?

Private

Join a group

Tell me about both

What type of accommodation do you perfer for most of your trip? (check all that apply if you wish a combination)

Safari Lodges

Luxury Tented Camps (permanent)

Mobile Camping - Classic (furnished)

Mobile Camping - Basic (sleeping bag)In Zanzibar

Inns (stone town)

Waterfront Resorts

What is your budget (per person excluding international air)?

Less than US $1,500.00

US $1,500.00 - $2,500.00

US $2,501.00 - $3,500.00

More than US $3,500.00

I have not made up my mind yet

Money is no object

What language do you most prefer your driver/guide to speak?

English

French

German

Spanish

Other

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