Title:

Mr Mrs Ms Dr. Prof.

First Name:

Last Name:

Country of Residence:

Email:

Telephone Number:

Area Code: Number:

Number of Adults:

n/a 1 2 3 4 5 6 7 8 9 10 11+

Will you be traveling with children?

No Children Children over 12 years Children under 12 years

Number of Children:

n/a 1 2 3 4 5 6 7 8 9 10 11+

Lodge Preference

No Preference Mark's Camp Tree Tops Lentaba Lodge

Arrival Date:

Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month January February March April May June July August September October November December Year 2008 2009 2010 2011

Departure Date:

Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month January February March April May June July August September October November December Year 2008 2009 2010 2011 2012

Unsure of Arrival and Departure?

No Yes

Do you need a transfer between P.E. and Lalibela?

No Yes

Enquiry/Special Requirements: