Safari Planning Questionnaire Welcome! We appreciate you taking the time to fill out the information below - please expect a reply within 24 hours. This information is confidential and The Africa Adventure Co. will only use the information for its own use and will not sell the mailing list to any outside parties. Contact DetailsName* First Last Address* Street Address City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Phone*Email* Safari SpecificWhat region do you want to visit?* Eastern Africa Southern Africa Central Africa Which Countries do you wish to visit?*View our maps: General Africa Southern Africa East Africa Open Kenya Tanzania East Africa Combo Uganda Rwanda Egypt Seychelles Ethiopia Other South Africa Zimbabwe Zambia Southern Africa Combo Botswana Namibia Malawi Mozambique Mauritius Madagascar What do you wish to experience in your safari?* Open Day Game Drives Night Drives Walking Safaris Boat Safaris Canoe Safaris Gorilla Trekking Chimpanzee Trekking Birdwatching Honeymoon Voluntourism Mountain Climbing Elephant Interaction Hot Air Balloon Safaris Horseback Safaris Scuba Diving/Snorkeling Fishing Train Safaris Beach/Island Getaways Cultural Visits Special Interest Safaris What level of safari do you prefer?* Open Luxury 1st Class Moderate Budget What style of travel do you prefer?* Open Independent Travel Group Program Private/Customized Combination How many in your traveling party?*What type of accommodations do you prefer?* Open Lodges Small Boutique Permanent Tented Camps First Class Mobile Tented Camps What are the age ranges of those traveling?* 0 - 10 years old 10 - 15 years old 16 - 21 years old 22 - 30 years old 31 - 40 years old 41 - 50 years old 51 - 60 years old 61 - 70 years old Over 70 years old Month or date range in which you prefer to travel?*Please see our: Best time to go chart January February March April May June July August September October November December Year in which you prefer to travel?* 2019 2020 2021 Length of travel itinerary?* 10 Days 12 Days 14 Days 16 Days 18 Days 19+ Days Individual Travel BudgetLand per person* $3,000-$4,500 $4,500-$6,000 $6,000-$8,000 $8,000-$10,000 $10,000-$15,000 $15,000-above Land and Air per person* $4,500-$6,000 $6,000-$8,000 $8,000-$10,000 $10,000-$15,000 $15,000-above CommentsHow did you hear about The Africa Adventure Company?* Return Client Africa's Top Wildlife Countries Guide Book Referral Galloping Gnus Newsletter National Geographic Adventure/Traveler Conde Nast Top Travel Specialist Travel & Leisure A List Travel Specialist Other Magazine Web Search - Google Web Search - Other (Please advise which in "Other") Blog Forum (Please advise which in "Other") OtherWho referred us?NameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.