Application Form

Personal Details

Surname______________________________________________________________________

Forenames ________________________________________________________________________

Name by which you like to be known_____________________________________________

Address______________________________________________________________________

Postcode__________________ Home Tel______________________ Mobile_______________

Work Tel__________________ Work email _________________________________________

Email Personal_________________________________ Occupation ____________________

Passport Details

Full name as on passport_________________________________________________________

Date of birth_____________ Place of birth_______________ Date of issue_______________

Place of issue________________ Passport no________________ Date of expiry__________

Nationality_______________ Marital status______________________

Note: Your passport must be valid until six months after the event.

Next of Kin: Name____________________________ Relationship ______________________

Address_______________________________________________________________________

Postcode_____________ Daytime Tel _____________________ Home Tel_______________

Mobile Tel___________________

Room Sharing

Accommodation will be shared. If you would like single accommodation or an upgrade to a chalet this will incur an extra cost to be met by you – this must be arranged in advance.

Special Dietary Requirements

Vegetarian Vegan Other (please state)________________________________________

Have you undertaken an overseas challenge for charity before? Yes/No

If yes, please give details:_____________________________________________________________

Booking: £270 non-refundable booking fee to confirm place. £350 remaining to be paid by 31 March. Flights can be booked with Key Travel, 0207 8439644 who specialise in humanitarian fares. (Do make comparisons as they are not always the cheapest). You can extend your trip and if you wish to enjoy this amazing country. Let me know if you need any suggestions.

Cost: 7 nights accommodation (plus an overnight stay in Lusaka on day of arrival - extra cost) (3 in stone tents at the lodge, 4 camping), food and water, for the 4 days out on the trip, transfers, visit to CLZ (Conservation Lower Zambezi), one game drive, (this may fluctuate slightly due to exchange rate) plus international flights with Emirates around £850. Kenya Airways also fly to Lusaka via Nairobi. NB Flight taxes can fluctuate so be mindful of this and flights booked in advance tend to be cheaper. Please make sure you arrive into Lusaka no later than specified date. Plus sponsorship.

Each participant is to commit to raising at least £1,500 sponsorship in addition to support CLZ and the Environmental Education Programme.

Extras: Meals for the nights at the lodge – inexpensive. Overnight stay in Lusaka $62.50 to be settled directly. Park fees are $25 per person per day (2 days). Any extra excursions, extensions, room upgrades, alcoholic, soft drinks, meals not included in the canoe element of the trip, $50 (cash) Visa entry to immigration on arrival in Zambia.

I have read, understood and agree to be bound by the Zambian Connection booking conditions. I have transferred my non-refundable registration fee of £270 to a/c 87943601 sort code: 09-01-27. Completed medical forms also need to be returned and travel insurance must be taken out at time of booking. Please make sure that you are covered for canoeing.

Signed_______________________________________________________________________

Print name____________________________________________________________________

Date ________________________________________________________________________

The Zambian Connection – Jane Keogh – mobile no. 07813 847205 – email: jane@janekeogh.co.uk