Prefix*	Mr Mrs Miss Ms
First Name*
Surname*
Nationality*
Address*
City*
Country*	Afganistan Albania Algeria American Samoa Andorra Angola Anguila Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerjaijan Bahamas Bahrain Bangladesh Barbados Belarus Belguim Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire (Ivory Coast) Croatia (Hrvatska) Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Greece Greenland Grenada Guadaloupe Guam Guatamala Guinea-Bissau Guinea Guyana Haiti Heard and McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea (north) Korea (south) Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malasia Malawi Maldives Mali Malta Marshal Islands Martinique Mauritania Maurritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Mynamar Namibia Nauru Nepal Netherland Antilles Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Marianas Islands Norway Oman Pakistan Palau 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 Seychelles Sierra Leone Singapore Slovak Republic Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobego Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States of America Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands (British) Virgin Islands (US) Wallis and Futuna Islands Western Sahara Yemen Yugoslavia Zaire Zambia Zimbabwe
Post code
e-mail*
Day Time Tel Contact Number*
Date of arrival dd/mm/year*	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
Date of departure dd/mm/year*	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
Dietary requirements	None Vegetarian Vegan Dont eat chicken Dont eat pork Dont eat fish
Number of Single tents required	0 1 2 3 4 5 6 7 8 US$75- per night including breakfast
Number of Double tents required	0 1 2 3 4 5 6 7 8 US$95- per night including breakfast
Number of Triple tents required	0 1 2 3 4 5 6 7 8 US$120- per night including breakfast
Number of Family units required (2 adults / 3 children)	0 1 2 3 4 5 6 7 8 US$120- per night including breakfast
Number of Family units required (5 adults)	0 1 2 3 4 US$160- per night including breakfast
Additional Activities	Please indicate the number of persons to participate in the activity
Full day Rafting	0 1 2 3 4 5 6 7 8 9 10 US$125- per person
Half Day Rafting	0 1 2 3 4 5 6 7 8 9 10 US$115- per person
Family Float Trip - Adult	0 1 2 3 4 5 6 7 8 9 10 US$30- per adult
Family Float Trip - Child	0 1 2 3 4 5 6 7 8 9 10 US$20- per child
Kayak School	0 1 2 3 4 5 6 7 8 9 10 US$115- per person per day tuition fee
Full Day Tandem Kayaking	0 1 2 3 4 5 6 7 8 9 10 US$145- per person (includes accompanying guide fee)
Soft Power Village Walk	0 1 2 3 4 5 6 7 8 9 10 US$15- person which includes a US$10- donation to SP
Please indicate in the comment box right date/s you would like to conduct any additional activities requested.

NB1. The Family units are priced for the use of 2 adults and accompanying children only

NB2. The Nile Porch with Nile River Explorers will as of the 1st July 2007 operate a free client shuttle service between Kampala and Jinja. Departure times and pick up points in Kampala are Kampala Backpackers at 7am, Lugogo mall (outside Game) at 7.30am and Red Chili Hideaway at 7.45am. The shuttle drops off at Explorers Backpackers in Jinja and will pick up from there for the return journey departing at about 6pm every evening. The shuttle drops off passengers at Red Chili Hideaway, Lugogo Mall and Kampala Backpackers in the evening. It is essential to book, this is done by either calling Nile River Explorers on +256(0)772 422373 or emailing nre@raftafrica.com. Conditions apply.

NB3. Payment can be made by Credit Card with an 8% surcharge levied/ US$/ Euro/ Pounds Sterling or local currency