Your Name

Your email address

Nationality

Date of Arrival to Tanzania - Specific 
(may be changed later)

Day MonthYear

 or General (i.e. "Spring 2004")

Length of time in Bush

 days

Length of time in Zanzibar

 days

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

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 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

Interests 
(check all that apply)

Wildlife
Culture
Scenery

Other

Number of people travelling

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

Private
Join a group
Tell me about both

Other information or comments