Booking Form

Tour Name (required)

Tour Date (required)

Full Name (required)

Date of Birth (required)

Address (required)

Telephone (required)

Email (required)

Passport No., Expiry Date & Nationality (required)

Existing or Previous Medical Condition/s

List of any Medication/s

List any Allergies or Special Dietary Requirements

Next of Kin (Name, Phone No. & Relationship) (required)

Bike Jersey Size (cm) (required)
XS - Chest 75-80 / Waist 64-70S - Chest 80-86 / Waist 70-76M - Chest 86-92 / Waist 76-82L - Chest 92-98 / Waist 82-90XL - Chest 98-104 / Waist 90-982XL - Chest 104-112 / Waist 98-1063XL - Chest 112-120 / Waist 106-114

Summary of Cycling Experience (required)

Hire a Road Bicycle? (required)
YesNo

Bicycle Hire Type
NoneCarbon Road BikeCyclo Cross BikeElectric Road Bike

Single Accommodation Supplement? (required)
YesNo

Information Regarding Flights & Travel Insurance?
YesNo

Additional Travel Assistance Pre or Post Tour?
YesNoMaybe

How do you intend to pay? (required)
Euro - Bank transfer$AUD - Direct deposit$AUD - VISA/MCARD (2% surcharge)$AUD - AMEX (3% surcharge)

How did you find about the tour?

I agree to be bound by the Terms & Conditions (required)
Agree

Booking Code (if relevant)