Untamed Encounter Form
We are excited to host you in Southern Africa on this immersive leadership adventure from the 2nd to the 9th of October. Please take a few moments to complete questions so that our team can make the most out of our time together. During the next few months we will be sending you more information on what to bring and how to prepare for your travels. In order to secure your spot, the form must be completed by April 15th and non-refundible deposit of $1000. Payment details will be sent after the form is submitted. 
Email *
First & Last Name *
Phone Number
Physical Address (We'll be sending you a few tools ahead of time)
Do you require any assistance in booking flights to and from Harare? (Ensure that you arrive before the 3rd and leave after the 8th of October).
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Do you have any food allergies or diet preferences? If so please describe. 
Describe your favorite meal.
On a scale of 1-10, how adventurous are you? *
Solo Travelers: Do you mind sharing a room with another solo traveler of the same sex?
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What would like to walk away with from this experience? *
Required
Please list your industry of work as well as any personal hobbies.  *
What is the most extreme thing you've ever done?
Who referred you to the Untamed Encounter Zimbabwe
Have you ever been to Africa? If yes, when and where. *
A copy of your responses will be emailed to the address you provided.
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