Trip Date ... *

Trip Name

Name

Address

Email Address

Place of BIrth (from Passport)

Date of Birth ...

Passport Number

City where passport was issued

Additional Tour Participants

Room Type Double Double with Twin Beds Single

Type of Bicycle Touring Bicycle Road Bicycle

Bicycle Size

Inseam Length

Arm Length

Type of Bicycle you currently use

Previous Bicycle Trips

Special Diet Requirements or Food Allergies

Do you have any specific medical issues t hat could cause an unforseen issue during the program.

I have read and understand the cancellation information. I understand that there are some risks involved in Outdoor Activities and I participate in above program knowing these risks. I will follow safety guidelines given to me by program provider and rules and regulations of local area. In programs that involve alcohol I understand it can impair my ability to perform and will STOP if I feel overwhelmed by the effects or will follow the guidance of my program leader if they suggest I take a break from the activity.

I Agree *

Date ...

Name