Arrival point and date. e.g. Cape Town International 26 June 2007

Departure point and date. e.g. Cape Town International 15 July 2007

Number of persons joining the tour

Select from List Transfers only Self Drive Guided self drive Fully guided tour (driver/guide).

Transportation requirements

Select from List Back Packers Mid Range Bed & Breakfast. Luxury Accommodation Sleep in the back of the vehicle

Accommodation requirements

Name and surname of agent (Yourself or travel agent)

E - mail address of agent (Yourself or travel agent)

Mailing address of agent (Yourself or travel agent)

What is the primary activity that you would like to engage in ? e.g. Scuba diving, whale watching, suntanning etc.

Are there any other specific activities that you wish to engage in ? e.g. bungy jumping, ballooning, aerial flips etc.

What areas of South Africa do you wish to visit ?

Do you have any special / requirements ? e.g. disabilities, dietary etc.

Select from List YES NO

If you are scuba diving, will you require diving insurance ?

If scuba diving how many dives per day do you wish to do, what is your level of training and what are your equiptment requirements ? e.g. 2 x dives per day, advanced divers, 1 x regulator, 2 x bcd's etc.

Any other special requests or requirements?