CHOOSE A DESTINATION		Select Kenya Tanzania Uganda =============		ARRIVAL DATE
NUMBER OF NIGHTS		Select a value 1 Night 2 Nights 3 Nights 4 Nights 5 Nights 6 Nights 7 Nights 8 Nights 9 Nights Beyond 9 Nights =============
NUMBER OF ADULTS		Select a value 1 2 3 4 5 6 7 8 9 10 10+ =============

YOUR BUDGET		Select a value Per Person: $1000 - $2000 USD Per Person: $2001 - $3000 USD Per Person: $3001 - $4000 USD Per Person: $4001 - $5000 USD Per Person: $5001 - $6000 USD Per Person: $6001 - $7000 USD Per Person: $7001 - $8000 USD Per Person: $8001 - $9000 USD Per Person: $9001 - $10000 USD Per Person: Beyond $10000 USD
IS BUDGET FLEXIBLE?		Select a value The above is my maximum budget Flexible: I can increase up to 20% if needed Very flexible. Plan me a trip I want. Don't focus on specific budget
STAGE IN PLANNING		Select a value Still dreaming...not sure am going to take this trip I know am going somewhere, just not sure which country I'm definately going, I know which country...let's go!
WHAT WOULD YOU LIKE TO SEE AND DO?		Any specific destinations or interests (e.g. culture, food, wine, romance, adventure, wildlife, etc.)? Special occasion? Relaxing vs. fast-paced trip? What would make this your dream trip?
YOUR FIRST NAME
YOUR LAST NAME
YOUR EMAIL
YOUR PHONE NUMBER
YOUR COUNTRY OF RESIDENCE		- Select your country of residence- Antarctica Argentina AustraliaAustria Bali / Indonesia Belize Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Cambodia Chile China Colombia Cook Islands Costa Rica Croatia Czech Republic Egypt England Fiji France Galapagos / Ecuador Germany Greece Guatemala Hungary Iceland India Ireland Israel Italy Japan Jordan Kenya Laos Madagascar Malawi Malaysia Maldives Mauritius Mongolia Montenegro Morocco Mozambique Myanmar (Burma) Namibia Nepal New Zealand Panama Papua New Guinea Paraguay Peru Poland Portugal Romania Rwanda Scotland Serbia Seychelles Singapore Slovakia Slovenia South Africa Spain Sri Lanka Switzerland Tahiti Tanzania Thailand Turkey Uganda Uruguay Venezuela Vietnam Zambia Zimbabwe