Wild and Free Dolphin Safari

Booking Form

Please fill out one form per person and press the SUBMIT button
* indicates Required Info

TRIP DATES please tick 2009: July 22-29: 7 nights July 29-Aug 5: 7 nights Aug 5-12 : 7 nights

2009: July 22-Aug 5: 14 nights July 29-Aug 12: 14 nights

2009: July 22-Aug 12: 21 nights

Name (as on passport) *
Title
Daytime Phone number *
Mobile phone number
email address * 
Address 1 * 
Address 2
Address 3
Post / Zip Code   * 
Country * 
Date of Birth (and Age if under 18) *
Nationality (as on Passport) *
Sharing with: (leave blank if single)
Special Needs: ie. vegetarian or special diet, allergies, physical or mental disabilities, health considerations.
Any questions or special requests?
PAYMENT FOR HOLIDAY
 A deposit of £200 secures your booking, full payment is due 90 days before departure.
I will post a cheque to Wild & Free, PO BOX 71, Pwllheli, LL53 5ND.
I wish to pay by Bank Transfer we will contact you with our bank details
I will pay by PayPal (inc. 4% processing fee) - please invoice me
I wish to pay in Euros - please invoice me
FLIGHTS
BOOK FLIGHTS HERE
You can book your flights to Marsa Alam (RMF) or Hurghada (HRG) online from here, after we confirm your reservation. Please do not book flights until we have confirmed your reservation.
How did you find out about Wild and Free Holidays?
 *

Declaration: I have read and understood the Booking Conditions and I agree that I will be bound to them. * I declare myself fit and competently able to swim in open water conditions. I have answered all the above questions truthfully and to the best of my knowledge. I am in good physical and mental health and I am not traveling against the advice of a medical practitioner. I acknowledge that traveling in Egypt may be of a hazardous nature of varying extent and I hereby accept full responsibility for any loss, liability, injury or damage whatsoever that I may experience during this journey. I am over 18 years of age.

PLEASE ENTER YOUR NAME:

 *
The parent or legal guardian of a client under 18 must sign on their behalf.
The information below is important but can be sent later (up to 30 days before departure)
Passport number
Insurance Company
Insurance Policy no.
Insurance Co. phone
Emergency Contact no.