Name of tour & date:___________________________

Participant Data & Interest Survey
Return to: Ibike, 4887 Columbia Drive South, Seattle, WA   98108‑1919   USA

Name (official) ______________________	Nick name _______	Age ______	Gender _____

Address	________________________________________	Ht _______	Wt ________

City		__________________________________	St/Prov ____	Code ____________

Phone:		Day (____)_____________	Evening (____)_______________	best time ____

		Fax (____)_____________	E‑mail ____________________________________

Passport		#_______________	Exp. date __________________

Nationality	________________	Occupation _____________________________________

Birthday	________________	Place of Birth ___________________________________

In Case Of Emergency Notify ___________________________	Phone(____)_____________

		Address __________________________________________________________

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 TERMS AND CONDITIONS". ____ Initial

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’s program.  _____ Initial

Room Preference:
Rooms are generally, but not always, double occupancy.  If you are not registering with a roommate, we will try to match people with roommates, if you wish, but a roommate cannot be guaranteed.  If you don't have a roommate, or don't want a roommate there will be a single supplement charge.  This represents the actually difference in the cost to the program.  Single occupancy cannot be guaranteed..  Check one:
     	Double occupancy – Double bed.  Name of travel companion:                                    .
     	Double occupancy – Two twin beds.  Name of travel companion:                                    .
     	Double occupancy – Twin shared (find me a roommate)
     	Single occupancy

My bicycling experience:

My international travel experience:

My current level of physical activity:

Special interests:

Dietary restrictions, special medications or other personal needs:

I first heard about this program through __________________________________________
And, my T‑shirt size is:       small        medium        large        x‑large