Wilderness Safaris, Preferred, Recommended, Offical, Premier, Travel, Agency

Journeys with Insight

Travel Questionnaire

In order to help us get to know your travel needs we have put together this questionnaire that will give us the basics. The time taken to fill out this form will help us get an itinerary option to you even sooner.

* Denotes required fields.

*First Name:


*Middle Initial:


*Last Name:


*Address 1:


Address 2:






*Zip Code:


*How did you hear of Piper & Heath?




*Best telephone at which to be reached:


Best time to call you:


*City/Country you will be traveling from:


*Travel Date From:


*Travel Date To:


*Size of travel party:


Travel budget per person:
(excluding international flights)


Which countries, properties, or safaris are you interested in?
(Be as vague or specific as you like.)


How would you describe your usual travel style?
(e.g. luxurious, adventurous, basic, rough, etc.)


How would you rate your interest in physical activity?


*Have you traveled to Africa before?


*Please select your main interests:

Special Occasion (anniversary, graduation, retirement, etc.)
Photography (as the main focus)
Other, please specify below:





Thank you for taking the time to fill this out.
We will be in contact soon!