SOUTH AFRICA: Johannesburg & Cape Town (A Tale of Two Cities and A Safari)
Travel Date: December 19 - 28, 2025
Contact us at travel@elevatetravelevents.com
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Email *
Traveler Information
First Name *
Middle Name *
Last Name *
Date of Birth *
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Street Address *
City *
State *
Zip Code *
Contact Number *
Country of Passport Issued
Expiration Date On Passport
Gender on Passport
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Other
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Emergency Contact Information
Emergency Contact Name *
Emergency Contact Number *
Do you have any food allergies or medical conditions we should be aware of in case medical treatment becomes necessary? If yes, please specify.
Primary Care Physician Information: Please provide the name and telephone number of your doctor.
Special Accommodations Request
Will you be sharing a room with a travel partner?
If yes, your travel partner information must be provided and they must complete this form too.
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Travel Partner's Full Name
Travel Partner's Email
Payment Options
Based on your selection, you will receive an invoice for the full payment or deposit/installments, and payment policies.
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Double: $4,200/per person
Deposit: $300/per person
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Release & Liability Waiver
I, the undersigned, understand and agree to the terms and conditions of the trip. I have reviewed the Liability Waiver - Terms & Conditions. I release Elevate Travel & Events from any liability for personal injury, loss, or damage to personal property during the trip. 

Please type in below your full name if you are in agreement.
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