Your Information Full Name: Home Address (street citystate/country) Email Address: Phone Number Date of Birth   Deposits (you have sent or are sending) Kilimanjaro Trek Deposit - $500 Safari Deposit - $500   Trip Itinerary Kilimanjaro Route you will be climbing? Dates Safari Itinerary (# of days) Dates Contact Information How many other people will be in your group? Name of the person you will be sharing a room/tent with if any? Contact information in an emergency (name phone number and email address)   Refund & Risk Policy 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: