Tilmelding * Enrolment * Inscription * SAVANNAH TREK

TILMELDINGSFORMULAR * ENROLMENT FORM * FICHE D'INSCRIPTION

	Savannah Trek
	Please fill out in English and press the SEND button at the bottom of this page.
Date:
First name:
Last name:
Full address:
Country:
Telephone:
Cell phone:
Cell phone:
E-mail:
Nationality:
Passport number:
Date of issue
Place of issue
Expiry date
Occupation:
Birth date:

Do you smoke?	yes
	no

Are you vegetarian or vegan?	yes
	no
Specific dietary
When do you want to participate?

Travel together?	Do you wish to travel together with other participants if possible?
	yes
	no

	If you want to travel with a friend, please state his/her name:


	Do you wish to travel back from Victoria to Johannesburg in the trekking car?
	yes
	no


Who to contact in case of emergency (i.e. parents):

Names:

Address:

Telephone:

E-mail:

Comments:

Where did you hear about EXIS?