Your Information Full Name Home Address (street /city/ state/country) Email Address Phone Number Date of Birth   Deposits Kilimanjaro Trek Deposit - $500 Safari Deposit - $500 Please remember that if you pay by PayPal or Credit Card there will be an additional 3% charge.   Trip Itinerary Booked Kilimanjaro Route you will be climbing Dates Safari Itinerary (# of days) Dates   Contact Information Other people you will be traveling with... Name of the person you will be rooming/tenting with if any... Contact information in an emergency (name phone number and email address)   Refund & Risk Policies Do you have any medical conditions that we should be aware of? I have read understand and accept the terms of the Masai Giraffe Cancellation Policy.   I have read understand and accept the conditions of the Masai Giraffe Release and Assumption of Risk document.   Security code:   * Do not enter anything in this field: