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Journey Registration Form
*
1.
Journey Destination
(Required.)
Hosted Journey Tanzania - February 3 - 14, 2022
Hosted Journey Rwanda - May 20 - May 30, 2022
Hosted Journey Kenya - July 1 - July 12, 2022
Hosted Journey Kenya - September 16 - September 28, 2022
Other (please write in)
*
2.
Name as it appears on your passport:
(Required.)
*
3.
Address
(Required.)
*
4.
Email
(Required.)
*
5.
Cell Number
(Required.)
*
6.
Date of Birth: MM/DD/YEAR
(Required.)
*
7.
Passport Number
(Required.)
*
8.
Passport Date of Issue
(Required.)
*
9.
Passport Date of Expiration
(Required.)
*
10.
Country of Issue
(Required.)
*
11.
Emergency Contact Information
(Required.)
Name
Email
Cell
*
12.
Room Preference
(Required.)
Standard
Superior
Executive
Suite
*
13.
Are you willing to share a room?
(Required.)
Yes
No
*
14.
If you are willing to share a room with a friend or family member going on the trip, please list their name.
(Required.)
*
15.
Dietary Restrictions
(Required.)
*
16.
Physical Limitations
(Required.)
*
17.
Kenya Travelers: Would you like to reserve a spot for the Hot Air Balloon Ride over the Mara followed by Breakfast on the Mara? ($550 each)
(Required.)
Yes
No
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