Elective Medical Form | Msafiri Tours

Medical Electives Booking Form

Please complete this booking form to include your address, and return to us with your deposit payment. If you do not have your pick-up and drop-off information at this point in time please leave these fields empty.

Full Names

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Telephone:

Existing employment or studies

Please tell us a little about what you are doing now, so we can provide the best possible program for you. Your Program Here Where possible please choose a start date as the first Monday of your chosen month.

Start date (Monday)

End date (Friday)

Any accommodation preferences at your family home stay

Make sure you have 12-month multiple trip travel insurance for your placement.

Have A travel Insuarance

I have Medical travel insurance

Buy Travel Insuarance

I will buy travel insurance

PAYMENT PREFERENCE

Please confirm whether you wish to receive a deposit invoice or an invoice for the full elective program cost. We ask that payment for either option is made within 2 weeks.

Deposit Payment

Deposit invoice of $250/£250

Full Program Invoice

Invoice for full program fee

RETURN TRAVEL

Please let us know if you have any questions about any aspect of your elective program.

Msafiri Tours is committed to respect the privacy of our clients and the personal information collected from them when booking trips to Africa. Personal information includes names, e-mail addresses, private addresses, telephone numbers and other information provided by a client. Msafiri Tours undertakes to make personal information available to employees (including those contracted to provide a service) on a need-to-know basis ONLY. It is our policy NOT to exchange, sell or disclose personal information to an outside party.

Medical Electives Booking Form

+44 7923802721

+256 783 704 342

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