Booking-Form-25-4716-IND-KWE | Gap Africa Projects

Wild Wellness camp booking form

Your Gap adventure starts here!

Please use the form below to submit your provisional booking to 4716: ‘Wild Wellness, a safari for the soul’ Programme

We will contact you for your deposit payment soon so we can finalise your placement

(NB: Your name should be given as displayed on your passport)
Title*
Name*
First Middle Last
Date of birth*

Day
Month
Year
Address*
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
Telephone (Do not enter +44 for UK numbers)*
Mobile (Do not enter +44 for UK numbers)*
Email 1*
Email 2
(**NB: Please note that all booking correspondence will be sent via Email**)
Passport no.
Passport Issue Date

Day
Month
Year
Passport Expiry Date

Day
Month
Year
Nationality of Passport
Next of Kin Details
Full name*
Relationship*
Contact Telephone (Do not enter +44 for UK numbers)*
Please provide details of any dietary requirements*
Please advise details of any medical conditions or allergies*
Consent*

I have read and understood the terms and conditions and confirm that all information contained in this form is correct (T&C’s available Here)