Your Full Name
Your valid email address
Telephone number
Fax
Your Country
Date of Arrival to Tanzania - Specific (may be changed later)
or General (i.e. "Spring 2004")
Length of time in Trekking
Length of time in Bush
Length of time in Zanzibar
Destinations 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
Destinations you want to visit in Eastern Tanzania (check all that apply)	Saadani National Park
Destinations 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 Kitulo Plateau National Park Udzungwa Mountain National Park Overnight in Dar es Salaam Other
Destinations you want to visit in Western Tanzania (check all that apply)	Mahale Mountain National Park Gombe Stream National Park Rubondo Island Katavi National Park
Destinations you want to visit in Zanzibar (check all that apply) Destinations in Zanzibar for excursions	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 interesting in climbing e.g. Mt. Kilimanjaro, Mt. Meru, etc. Please indicate Mountain climb preference	5 Day Marangu Route Kilimanjaro 6 Day Marangu Route Kilimanjaro 6 Day Machame Route Kilimanjaro 7 Day Machame Route Kilimanjaro 6 Day Rongai 3 Days Mount Meru Oldoinyo Lengai Mount Kenya Udzungwa Mountains Eastern Arc Mountains Other
Interests (check all that apply)	Wildlife Tribal People (e.g. Maasai) Culture Scenery Other
Total Number of people travelling
Male
Female
Children with their ages at the safari dates
Do you want a private safari or would you prefer to join a group?	Private Join a group Tell me about both
What type of accommodation do you prefer for most of your trip? (check all that apply if you wish a combination)	Safari Lodges Luxury Tented Camps (permanent) Mobile Camping - Classic (furnished) Mobile Camping - Basic (sleeping bag) In Zanzibar Inns (stone town) Waterfront Resorts
What is your budget (per person excluding international air)?	Less than US $1,500.00 US $1,500.00 - $2,500.00 US $2,501.00 - $3,500.00 More than US $3,500.00 I have not made up my mind yet Do not like to mention
What language do you most prefer your driver/guide to speak?	English French German Spanish Other
Other information or comments

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Selina Experience Africa Safaris

TANZANIA

Box 592, ARUSHA
TelFax: +255 27 254 5205

Cell: +255 715 866633

AUSTRALIA

1/184,Salisbury Hwy Road

Salisbury 5108 South Australia.
Tel/Fax: +61883494545

Cell: +61402765763

info@selinaexperience.com

©Selina Experience Africa Safaris® is a an experienced tour operator in East Africa which turn a stumbling stone into a stepping stone when planning for safaris to East Africa

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