Name First Last Birth date Sex*MaleFemalePassport number*Expire Date* Marital StatusSingleMarriedWidowedDivorcedSeparatedOccupationHome Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Home*WorkCellFaxEmail* Shirt Size CateringLiquorSoft DrinksJuicesFoodFood DislikesVegetarianSpecial Requests HealthAllergiesSpecial MedicationBlood Type Safari DatesArriving Date* Arriving Time : HH MM AM PM Arrival Flight nrDeparting Date* Departing Time : HH MM AM PM Departing Flight nr Fire Arm No 1MakeModelCaliberSerial NrNumber of Bullets Fire Arm No 2MakeModelCaliberSerial NrNumber of Bullets Next of Kin (Not coming with you on Safari)NameRelationshipAddressTelHomeWork Clearing agent address & contact detailsBroker NameBroker AddressBroker TelBroker Email Taxidermy address & contact detailsTaxidermy NameAddressTelEmail Notes Kindly take note that we advice clients strongly to submit their CITES import application forms to USFW agent the week after they get back from their Safari. Sadly we cannot assist you with this service, but all the mayor clearing agents know how to do this process and will assist you. One of the new requirements by USFW is that they need the GPS coordinates where the animal was killed, and this can only be determined after the hunt. We strongly recommend the services of D&L Logistics in Chicago for entry of Lions and Leopards into the USA. Kindly take note that for 2019 NO Elephants will be importable into the USA. This iframe contains the logic required to handle Ajax powered Gravity Forms.
