Request for Information

Thanks for your interest in a our unique safaris & journeys. Please fill out the following form so that we can better serve your special travel needs. We do require minimum personal information including your first, last name and e-mail. If you would like us to send you our FREE brochure please include your full address below or Call us if you have any questions toll free at: 1 (888) 995-0909

Contact Information

All fields with * are required in order for you to submit the form.

First Name*:
Last Name*:
Address One:
Address Two:
City:
State:	Zip:
Country:
E-mail Address*:
Day Time Phone*:
Evening Phone:
Have you booked a journey through Uncharted Outposts International before?	YesNo
	Please call me directly at the above phone numbers so that we can talk about my travel plans and details.

Trip Information

What is your Destination choice?:	Select One East Africa Southern Africa Australia New Zealand South Pacific South America Central America North America
Travels Dates:
Departure date (mm/dd/yy):	Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2006 2007 2008
Return date:	Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2006 2007 2008
Are you flexible on your times of travel?	Yes No
Where are you leaving from?
Departure airport:
	I am unsure of my departure airport
Who is going (number of people)?
Adults (12 and over):
Children (11 and under):
How soon do you plan to book your travel arrangements?	Within the next 2 to 3 weeks Within the next 2 to 3 months Within the next 6 months Within the next 12 months

Travel & Accommodation Information

Please list the following elements of your journey in the order of their importance. For example: the most important aspect for you may be wildlife observing; the least important aspect may be the accommodations.

Most Important (1):	Most important Wildlife/nature observing Cultural experience Activites (e.g., game drives etc.) Accommodations Budget/Cost of trip Length of Stay
2nd Most Important (2):	Second most important Wildlife/nature observing Cultural experience Activites (e.g., game drives etc.) Accommodations Budget/Cost of trip Length of Stay
3rd Most Imprtant (3):	Third most important Wildlife/nature observing Cultural experience Activites (e.g., game drives etc.) Accommodations Budget/Cost of trip Length of Stay
4th Most Important (4):	Fourth most important Wildlife/nature observing Cultural experience Activites (e.g., game drives etc.) Accommodations Budget/Cost of trip Length of Stay
Least Important (5):	Least most important Wildlife/nature observing Cultural experience Activites (e.g., game drives etc.) Accommodations Budget/Cost of trip Length of Stay
What type of trip are you interested in?	Very active - very active journey, no laziness Active - active trip with a little time for siesta Relaxed - sheer lethargy Mixture - a little bit of everything
What type of accommodations are you interested in?	Adventurous - clean and comfortable, no frills Moderation - nice, comfortable, some frills Luxurious - give me luxury, I feel like being pampered Mixture - a little bit of everything
Number of bedrooms?	01 02 03 04 05 06 07 08 09 10

Budget Information

What is the approximate budget for your trip?

Per person (US$)

Select One $2,500-$3,500 $3,500-$5,000 $5,000-$7,000 $7,000-$9,000 $9,000+ (excluding international airfare)

Other Information

How did you get to the UOI web site?	Select One Friend Past traveler Browsing Media Portal (travel) Travel agent
Other:
How would you like us to get back to you with your special custom-designed safari? (Check all that apply)	E-mail me Snail mail me Fax me Call me during the day Call me during the evening
How quickly would you like us to respond?	Urgently (within the next 24 hours) Very Soon (within two business days) Soon (as soon as we can)
Please use the space below for any additional questions, comments or information.

 

Uncharted Outposts, Inc.

9 Village Lane
Santa Fe, NM 87505
T: (505) 795-7710
F: (505) 795 7714
E: travel@unchartedoutposts.com




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