WildEarth Live Safari – February 6th

We are very excited for you to be joining us for this live safari! Sit back and relax as we get to learn about the wildlife in numerous reserves in South Africa. But first, we just need you to fill out this quick form.

Note:

IMPORTANT: This program features live coverage of an African safari and may include animal kills, carcasses, scenes of mating, etc. Viewer discretion is advised.
You will need a parent/guardian’s digital signature at the end of this application if you are under 18 years old.
Please avoid pressing the back/refresh button in your internet browser, as this might mess up your online application.

1. Student Contact Information

MPS Email *This question is required. This question requires a valid email address.

Student ID *This question is required. This question requires a valid number format.

First Name *This question is required.

Last Name *This question is required.

Birthdate This question requires a valid date format of MM/DD/YYYY.

calendar

Student Phone This question requires a valid number format.

Personal Email This question requires a valid email address.

Are there any special accommodation requests that you'd like us to know about?

Please tell us more:

2. School Name

3. How did you hear about us? *This question is required.