Bukima Adventure Booking form tour

Booking Form

booking form

Your Tour Details
Tour Code	Tour Name(s)	Departure Date	From	To

Details

Important: Names must be Exactly the same as your passport.

Client	First Name	Surname	Nationality	Date of Birth
1
2

Client	Email Address	Occupation	Special Dietary Requirements
1
2

Passport details

Client	Passport No	Place of Issue	Issue Date	Expiry Date
1
2

Address for all Correspondence

Street address		City/Town	State

		Postcode/Zip	Country

Home Phone	Work Phone

Travel Insurance

Would you like us to arrange travel insurance for you?

Pre-Tour Accommodation

Do you require pre-tour accommodation?	Tour departure Point:	Date In pre-tour:	Request room type:

How did you locate Bukima.

Internet.	Advertisement:	Other:	Past passenger or friend.

Travel Agent booking details:

Agency Name:	Agent Name:	Agent Email:	Agent Phone:

Credit Card Payments:

would you like to pay by credit card? enter your details below.
Credit card details must match at least one of the clients travelling details.
Please write your credit card details here Name, expiry date, and your security number on the reverse of card.

PLEASE NOTE: a 3.5% credit card fee for UK and Australia and 4% fee for US and Canada may apply.