Title * Mr.Mrs.MissDr.

First Name *

Last Name / Group Name *

E-Mail *

Country *

Arrival Date *

Departure Date *

Duration of stay (number of nights) *

Number of Persons *

Accommodation Category (hold Ctrl/Command + click for more interests) * Camping or BandasBudgetMid RangeLuxury

Budget Indication (per person) * $1.500 - $2.000$2.000 - $3.000$3.000 - $4.000over $4.000

Which of the following tariffs do you require? (hold Ctrl/Command + click for more interests) * Bed & BreakfastHalf BoardFull Board

Please specify your Interests and Intended Activities (hold Ctrl/Command + click for more interests) Game DriveBirding / Bird WatchingGorilla Tracking / Trekking"Big 5" Species SafariCultural / Community TourismPrimate TourMountaineering / Hiking / WalkingMedia; Photography / Film ProductionField Study; Butterflies / Reptiles / OtherEco / Responsible Tourism / ProjectSustainable Tourism / Carbon Footprint / Project

How did you hear about PearlAfric? Visited a Trade Event / Tourism ShowMedia; on Radio / TV / Word of mouth / recommendationOn-line Advertising / Sponsored LinkSearch Engine (GoogleBing etc.)None of the above

Comment, Remark or Question

5 + 0 = ? Please prove that you are human by solving the equation *