Name*

Company

Email*

Telephone*

Fax

Mobile

Physical Address

Event Dates

Number of days

Number of delegates

Arrival

Departure

Seating

Equipment required

Computer Training	VCR	Flip Chart
Lecturn	White Board	Computer Projector
Overhead	Translation	Public Address
Secretarial Services	Video Conferencing
Television	Slide Projector

Breakaway Rooms

Yes

No

No. Rooms

No. of delegates per room

Accommodation required

Yes  No

No. of Delegates

Single No. Sharing No.

Accommodation dates

No. of nights

Arrival

Departure

Leisure activities

Action Cricket	Fishing	Go-carting
Boat Cruises	Hunting	Gym
River rafting	Casino	Bungee
Eco Activities	Tribal Dances	Soccer
Game Drives	Water Sports	Squash
Golf	Bird Watching	Team Building
Tours	Boma	Dancing
Hiking	Theme Evening	Other

Extra requirements

Baby sitting	Beauty Salon
Medical care	Malaria Free
Wheel chair

Special requests

Area, Province or City where Conference should be held

Approximate budget guidelines Total budget

Per person per day: