Tilmelding * Enrolment * Inscription * SAVANNAH TREK

TILMELDINGSFORMULAR * ENROLMENT FORM * FICHE D'INSCRIPTION

	Savannah Trek
	Please fill out in English and press the SUBMIT button at the bottom of this page.
Date:
First name:
Last name:
Full address:
Country:
Telephone:
E-mail:
Nationality:
Passport number:
Education:
Birth date:

Do you smoke?	yes
	no

Are you vegetarian or vegan?	yes
	no

Expected arrival date:

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:


Cape Town	Do you wish to spend one week in Cape Town before the Trek?
	yes
	no


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

Names:

Address:

Telephone:

E-mail:

Comments:

Where did you hear about EXIS?