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The United Touring Company's

Electronic Booking Service


Please note: Although it is most unlikely that you will experience any problems responding to this form, certain non-standard browsers will not respond properly. If you experience any difficulties, (or if you are not using a forms-capable browser) you may email your response to this form to: UTc at AfricanAdrenalin.

E-MAIL ADDRESS:                   
                                                    

SURNAME MR/MRS:                   
                                                    

FIRST NAME:                       
                                                    

PHONE(BUS):                       
                                                    

FAX:                              
                                                    

PHONE(HOME):                      
                                                    

ADDRESS:                          
                                                    

CODE:                             
                                                    

DATE OF BIRTH:                    
                                                    

OCCUPATION:                       
                                                    

PHYSICAL CONDITION:               
                                                    

NATIONALITY OF PASSPORT:          
                                                    

PASSPORT NUMBER:                  
                                                    

NAME AND ADDRESS OF NEXT OF KIN:  
                                                    

DIETARY PREF eg VEGETARIAN:       
                                                    


PRODUCT CODE (eg. AT50):          
                                                    

DESCRIPTION (eg. KARIBA MODULE):  
                                                    

DATE OF ARRIVAL:                  
                                                    

DATE OF DEPARTURE:                
                                                    

PERSONS (PAX):                    
                                                    


PRODUCT CODE (eg. AT50):          
                                                    

DESCRIPTION (eg. KARIBA MODULE):  
                                                    

DATE OF ARRIVAL:                  
                                                    

DATE OF DEPARTURE:                
                                                    

PERSONS (PAX):                    
                                                    


PRODUCT CODE (eg. AT50):          
                                                    

DESCRIPTION (eg. KARIBA MODULE):  
                                                    

DATE OF ARRIVAL:                  
                                                    

DATE OF DEPARTURE:                
                                                    

PERSONS (PAX):                    
                                                    


PRODUCT CODE (eg. AT50):          
                                                    

DESCRIPTION (eg. KARIBA MODULE):  
                                                    

DATE OF ARRIVAL:                  
                                                    

DATE OF DEPARTURE:                
                                                    

PERSONS (PAX):                    
                                                    


Contact AfricanAdrenalin if your requirements cannot be accomodated on our e-form.

I HAVE READ AND UNDERSTAND THE BOOKING CONDITIONS.

BOOKINGS WILL ONLY BE FINALISED AFTER WE HAVE PROCESSED YOUR PAYMENT DETAILS AND HAVE e-MAILED YOU WITH CONFIRMATION.

 

 
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Tel: +27 11 888 4037
Fax: +27 11 888 1041
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