Program name 

--Select One--
Rwanda-Uganda Bike Industry Tour
 date 

Official Name   Nickname 

Nationality   
Passport   #  Exp. date   

Gender:FM   Age    Height    Weight 
Birthday   Place of Birth 

Occupation  

Address1    
Address2    
City        
State/Prov     Zip/Postal Code 
Country     
           
Tel. Day     
Tel. Evening
Fax         
Best hour to receive telephone calls 
--Select One--
Morning
Afternoon
EveningAnytime

E-mail      

In Case Of Emergency Notify: 
Name          
Relationship
Tel         
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".
  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’s program.
  Yes   No

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.
Select One Double Occupancy - Double Bed Double Occupancy - Two Twin Beds Double Occupancy - Twin shared (find me a roommate) Single Occupancy

Name of travel companion 

My bicycling experience:

My international travel experience:

My current level of physical activity:

Special interests: I would especially like to see or learn about....

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

I first heard about this program through

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

Other questions and/or comments:

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