BOOKING FORM
Your contact details
Your name:
Home address:
Telephone number:
Email address:
Level of engagement

What is your expected level of engagement with Wild Philanthropy?

Legacy Travel






Legacy Membership



Bespoke Legacy
Your emergency contact
Name and relationship to you:
Address:
Telephone number:
Clients
Client details (Only to be completed if Legacy TRAVEL is selected)
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Title:
First name and initials:
Surname:
Occupation:
Nationality:
Country:
Date of birth:
Weight (kg): *
* Please note we require this information in order to calculate exact weight load on bush aircraft.
Passport (Only to be completed if Legacy TRAVEL is selected)
Passport number:
Passport Issue date:
Passport expiry:
Passport place of issue:
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Dietary requirements and medical conditions / disabilities (Only to be completed if Legacy TRAVEL is selected)
Please list any dietary requirements or food allergies:
Please state if none.
Please list any medical conditions that may affect your holiday or if you have any special requirements (e.g. allergies, pregnant, asthmatic):
Please state if none.
Other special requests:
Please state if none.
International Flights (Only to be completed if Legacy TRAVEL is selected)
Please list departure city, destination city, times, dates and flight numbers.

Confirm flight details later
Arrival details:
Departure details:
Travel Insurance (Only to be completed if Legacy TRAVEL is selected)
Confirm insurance details later
Name of Insurer:
Insurer Telephone Number:
Policy Number:
Note: Please ensure that your policy covers accident, emergency repatriation or medi-vac and also cancellation of trip.
Legacy Travel Payment Details (Only to be completed if Legacy TRAVEL is selected)
Payment to be made by another party
Deposit:
Total Enclosed:
Payment Options
Wire transfer (Tick to request bank details. Please ensure you pay all bank charges of transfers).
Cheque (All cheques should be made payable to JOURNEYS BY DESIGN and marked account payee only).
American Express Card (We will contact you for details. This card carries a 2.0% fee. All other major credit cards carry fees starting from 3%).
Legacy Membership Payment Details (only to be completed if Legacy MEMBERSHIP selected)

First annual payment in full. Legacy Membership is for a minimum of three years.

Years commitment to membership:
3 years
4 years
5 years
6 years
7 years
8 years
9 years
10 years
Payment to be made by another party
Amount to be paid to enterprise (56%)
Amount paid to foundation (44%)
Total Enclosed
Payment Options
Wire transfer (Tick this box and we will send you both enterprise details and charitable account details. Please ensure you pay all bank charges and transfers).
Cheque (All cheques should be made payable to JOURNEYS BY DESIGN and marked account payee only).
American Express Card (We will contact you for details. This card carries a 2.0% fee. All other major credit cards carry fees starting from 3%).
Your financial protection
When you buy an ATOL protected air holiday package from us, you will receive a confirmation invoice from us confirming your arrangements and your protection under our Air Travel Organisers Licence 9680. In the unlikely event of our insolvency, the CAA will ensure that you are not stranded abroad and will arrange to refund any money you have paid to us for an advance booking. For further information, visit the ATOL website www.atol.org.uk

Terms and Conditions for booking with Journeys By Design
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