EmailMe Form - DRIFTERS TOUR BOOKING ENQUIRY

Name *

First Last

Gender

Male

Female

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Email Address *

Phone (Primary Contact)

Fax (If Required)

Date of Birth

DD / MM / YYYY

Nationality *

Passport or ID Number

Dietary Preference

Please let us know about any physical or medical conditions we should be aware of

Tour Selection *

Departure Date *

DD / MM / YYYY

ACCOMMODATION REQUIRED BEFORE AND AFTER THE TOUR

If you require accommodation at Drifters Johannesburg Lodge and/or Cape Town Lodge before and/or after the Tour, please select below:

Number Of Guests

Accommodation Before Tour

Yes

No

Check-in

DD / MM / YYYY

Accommodation After Tour

Yes

No

Check-out

DD / MM / YYYY

Accommodation Type

AIRPORT TRANSFERS

If you require Airport Transfers, please select here :

Transfers from Airport to Lodge

Yes

No

Flight Arrival Date and Time

DD / MM / YYYY HH : MM AM/PM

Transfer Time Selected

Airline and Flight Number

Transfers from Lodge to Airport

Yes

No

Flight Departure Date and Time

DD / MM / YYYY HH : MM AM/PM

Transfer Time Selected

Airline and Flight Number

ADD-ONS

Please select any equipment that you would like added to your order :

Equipment

Sleeping Bag

Drifters T-Shirt

Third option

If T-shirt Selected

NEXT-OF-KIN

Please provide contact details for next-of-kin

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

PAYMENT DETAILS

Please provide either proof of payment, or credit card details below below. Please note that the card used to ecure this booking MUST be present on arrival for the Tour in order to complete the verification process.

Total Price (including add-ons) *

€ Euros . Cents

Proof of Payment (if paid)

Card Type

Card Number

Expiry Date

DD / MM / YYYY

Last 3 Digits On Reverse Of Card

ACCEPTANCE

I have read and fully understand the conditions and general information as set out by Drifters. I acknowledge that it is entirely my responsibility to ensure that I am adequately insured for the above venture. I furthermore absolve Drifters, their staff, management and affiliates from any liability whatsoever, and realise that I undertake the above venture entirely at my own risk.

*

I accept

By clicking this button I accept the terms and conditions described above.

Date *

DD / MM / YYYY

Place *