Educational Programs


Cuba Educational Program Registration Form

Program Name   and Date 

Name (official)      Nickname 

Nationality     Passport #   Exp. date   

Gender:    FMX       Age    Height    Weight 

Birthday       Place of Birth 


State/Prov     Zip/Postal Code  

Tel. Day       
Tel. Evening  
Best hour to receive telephone calls 


In Case Of Emergency Notify:

Acceptance Of General Terms And Conditions: I have read and understand the document, 
"GENERAL TERMS AND CONDITIONS".  I accept and agree to be bound by the "GENERAL 
Yes No Understanding Of Legal Contract: I have read and understand that the agreement entitled
"VOLUNTARY WAIVER AND RELEASE FROM LIABILITY AND INDEMNITY AGREEMENT" is a LEGAL CONTRACT.  I have read each paragraph very carefully and made certain that I fully understand what the paragraph says.  If I do not fully understand, or do not fully agree to the terms I WILL NOT INDICATE THAT I DO.  I understand that I can go elsewhere to bicycle and travel if I do not agree to these terms.  I have not been forced in any way to agree to this document, and am doing so because I am willing to accept all risk associated with bicycling and traveling in order to participate on Ibike‚Äôs program.
Yes No Rooming Preference:  Rooms are generally, but not always, double occupancy -- we encounter a variety of lodging conditions that aren't able to accommodate all desires.  If you are not registering with a roommate, if you wish, we will try to match people with roommates, but a roommate cannot be guaranteed.  If you; want a "twin shared room" that is not available, don't have a roommate, or don't want a roommate there may be a single supplement charge. This represents the actually difference in the cost to the program.  Similarly there may be situations where single occupancy cannot be guaranteed. To facilitate planning, please let us know your rooming preference.
Rooming Preference:
Name of roommate  (if relevant)

My bicycling experience:

My international travel experience:

My current level of physical activity:

Special interests: I would especially like to see or learn about.... (e.g. art, social justice, apiary, etc)

Dietary restrictions, allergies, special medications or other personal needs:

I first learned about this program through

And, my T-shirt size is: small   medium  large  x-large

Other questions and/or comments:

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