Personal Details

Number of Adults:

Number of children under 10 years:

Client Name:

Contact Number:

E-mail:
*Please enter a valid email address.
Home Address:

Next of Kin Contact Details:

Special Requests (eg diet, health problems etc):

What type of Room do you Require:

Optional Activities (if "Yes", please select from list below):

List of Activities:

Travelling details

Arrival Date:

Total Nights at the Lodge:

Departure Date:

Payment Details

Select relevant:

Please Note: A 5% admin fee is applicable on all credit card transactions Please include this amount in the amount to debit.

Card holders Name:

Amount to Debit:

Card Type:

Bank Name:

Card Number:

3 Digits on reverse of card:

Expiry Date:


Reservations are confirmed only after receiving the full payment. All bookings must be confirmed via fax or e-mail. A fee of 50% shall be levied if cancellation is 31 - 14 days prior to arrival. A fee of 100% shall be levied if cancellation is 14 days or less prior to arrival. Please read our terms and conditions by clicking on the link below.

I have read and fully understand the terms and conditions and accepted them:




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