CONTACT US: Offices: Plot 10 Ntinda Kisasi Road, Opposite Texas House, Uganda - Kampala Email: info@gorillaadventuresafaris.com P.O. Box 353 Mukono Tel:+256-392-848 197, +256754-242 307 ONLINE ENQUIRY FORM Thank you for your interest in Gorilla Adventure Safaris. Please fill in the form below with as much detail as possible to enable us provide you with a tour that will suit your needs.
	Traveler Name* Street / PO Box City State / Province Postal Code Country* Select Country United States United Kingdom Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos Islands Colombia Comoros Congo Congo Democratic Republic Cook Islands Costa Rica Cote D'ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-bissau Guyana Haiti Vatican City Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea South Korea North Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libyan Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and The Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania Thailand Timor-leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Email* Day time contact # Mobile Phone How many people wish to travel? 1 2 3 4 5 6 7 8 9 10 11 12 Number of days on trip? 1 2 3 4 5 6 7 8 9 10 11 12 Number of single rooms 0 1 2 3 Number of double/twin rooms 0 1 2 3 On what date would you like to begin your tour? 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec 2009 2010 Which Tour - indicate the featured tour you want to register for or if your are requesting details for a custom-made itinerary please outline your proposal in the text box further down this form. 3 Days Gorilla Safari 4 Days Queen Elizabeth NP 3 Days Safari Murchison Falls 3 Days Queen Elizabeth Safari 7 Days Primate Safari 12 Days Luxury 15 Days Uganda Adventure Safari 9 Days Gorilla Safari 10 Days Birding Safari 21 Days Uganda Birding Safari 10 Days Rwenzori Mountain Trek 7 Days Rwanda Uganda Safari 7 Days Nairobi - Kampala Trekking Safari 8 Days Mountain Elgon 11 Days Cultural Safari Please note that for persons wishing to partcipate in Gorilla Tracking activities the minimum age is 15 years. Please specify any special requests or alternative tours of interest to you or outline your 'Tailor-made' tour below?     * Denotes Required Field Your email address is a required field for the successful completion of this form as you will receive a confirmation of the submission