Name_____________________________________________________________________

Address__________________________________________________________________

Telephones___________________________________

Emergency Contact__________________________________________________________

Passport Number  __________  Expiry Date  _____________  Place of Issue  ____________

Health or Dietary requirements________________________________________________

Tour  ________________   Date    ____________

I would like a single room   _______         Please arrange a roommate for me  _______

I the undersigned, wish to partcipate in the trip I have specified above. I am fully aware of all the risks and hazards that might occur as a result of my participation in said trip or workshop or any such programme that I participate in with Flora and Fauna Fieldtours. Therefore if this application is accepted, myself, my heirs, executors and administrators remise, release and forever discharge Flora and Fauna Fieldtours and which ever travel agent is current as applicable, and all their employees, officers and owners and agents from any and all claims, demands, actions or causes of action on account of any losses, injury or death which may occur from any cause during such a programme as specified above as well as all matters and events incidental thereto.

My signature indicates that I have read the above document and agree to its terms. I further 
warrant that I am in good physical condition and am fit to participate in this trip/workshop.

Signature   _______________________________  Date    _______________________

Each participant must sign this release.

We strongly advise customers to purchase canc. & medical insurance for all international tours.