Reservation form

Fields with * are required
Desired date of arrival (Day 1)*:
With how many people are you?*
First name*:
Last name*:
Male   Female  

Email address*:
Telephone number*:
Date of birth*:
Passport number:
Passport valid until:
Street address*:
Postal/ZIP code*:
Residence (City/Town)*:
Contact person in emergencies:
Contact person telephone number:
Medical requirements?
Dietary food conditions?
Trave insurance with:
Travel insurance account number:

Where did you hear about Expedition Kilimanjaro?

* I have read and accept the travel conditions.