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Information Form for an African safari!

We love Africa and African safaris! We live and breathe African safaris every day!
You won't find another African Safari travel company with our knowledge and our passion for Africa, its wildlife and its safari destinations.
If you have questions about going on African safari or a holiday in Africa, feel free to give us a call or fill out the form below.

African Safari Information Request Form
(or use the link at bottom to send us an email)
  Please complete and click Submit (items with * are required).   Thank You!
Name (First, MI, Last)*
   
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Telephone
          Fax  
Email
Please contact me by
Email    Phone    Do not contact
Have you visited Southern Africa?

Anywhere else
in Africa?

If yes, where and when did you travel?
What time of year are you looking to travel?
Activities / interests you would like to enjoy on your safari
adventure
beach / spa
culture
fishing
hiking / fitness
photography
romantic getaway
scuba / snorkel
wildlife
wine / fine dining
List any specific wildlife interests (birds, predators, cats, etc.)
Anything in particular you would like to avoid?
Check countries you are interested in visiting
Botswana
Malawi
Namibia
South Africa
Zimbabwe
Zambia
Seychelles Islands
East Africa / Other
Number of people traveling and their respective ages
Any special requirements (diet, allergies, medical, sleep apnea etc.)
Are you interested in a specific tour or safari guide from our site?
If not please specify length of your ideal trip and any other details
Do you require airline reservations?



If yes, from what city? 
Are you a travel agent?
YES   NO
How did you hear about us?
  Specify
Additional Comments

       

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If you'd rather contact us by email or telephone, then you'll find all of our details at the bottom of this and every page in this website. Feel free to call or email us, we'd love to hear from you.


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           Eyes on Africa is a member of ATTA - African Travel and Tourism Association            Wilderness Wildlife Trust            Eyes on Africa sponsors Children in the Wilderness
                   Eyes on Africa is proud to be a certified Fundi - a South Africa Tourism Specialist            Eyes on Africa is endorsed by IATAN - International Airlines Travel Agent Network            Eyes on Africa is a corporate sponsor of The African Wildlife Foundation            Eyes on Africa is a member of the Better Business Bureau             Eyes on Africa is a member of ASTA - The American Society of Travel Agents (member #900143776)


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Eyes on Africa, Ltd.
1743 West Fletcher Street
Chicago, Illinois 60657

Tel: 800.457.9575 / 773.549.0169    Fax: 773.327.2977    Email: nicky@eyesonafrica.net

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All images © 1995-2008, James Weis
(unless otherwise noted). All rights reserved.
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modified: April 25, 2008
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