Bike
TOUR NAME: ญญญญ________________________________________________________
DATES:_____________________________________
PRICE: (from Bike
FULL NAME___________________________________________ DATE:___________________
AGE________M/F________ DIETARY
RESTRICTIONS________________________________
MAILING
ADDRESS_____________________________
CITY/STATE_________________________________________
TEL(Home)_________________________TEL(Cell or Work)______________________
E-MAIL___________________________________________
EMERGENCY
CONTACT:_____________________________________________________
EMERGENCY TEL:
work: ________________home
or cell:_________________ HEALTH CONCERNS
____________________________________________________________________________ญญญ__
HEALTH
INSURANCE COMPANY (health insurance is required) :
__________________________________________________________
ACCOMMODATIONS:.
( ) I would like a single room ($70 /night extra charge)
( ) I
will share a double room with_______________________and
prefer
(
) 1 double bed or (
) twin beds
( )
Please assign me a roommate if available
BIKE RENTAL: I wish to rent : (
) Straight handle bar road
bike ( )
bringing my own
Rentals: Bike Size___________ your height_____________ inseam________________
CYCLING
ABILITY ( )Expert 30+ mi/day ( ) Intermediate 10-30 mi/day ( )
beginner 0+ mi/day
PAYMENTS: Please include a check or
money order for the $100 deposit with this booking. Deposit is non-refundable. The
balance is due 30 days before the tour start date, refundable minus any
non-refundable reservation expenses for which we are responsible.
Mail this
form, along with deposit, and
signed liability waver form (required) to:
Bike
http://www.bikenewengland.com/ Email: info@bikenewengland.com