Booking Form

Contact Information

*Name (as specified on Passport)
*Passport Number
*Work Phone
*Home Phone
FAX
Address Line 1
Address Line 2
Address Line 3
City
State or Province
Postal Code
E-mail
*Emergency Contact - Telephone
*Emergency Contact - Relationship
*Date of Birth (dd/mm/yyyy)
*Sex	Male Female
*Height (cm) ( 1 in. = 2.54 cm )
*Inseam Measurement (cm)
Nationality
Occupation

Choose one of the following tours (use the scrollbar to see all selections):

  <Select A Tour> Schools - SIS Sabah Group 247 - April Group 247 - May Group 247 - June Gateway - July South China 4 day - April 3-6 South China 4 day - May 10-13 South China 4 day - Oct 4-7 HIKE (Hike the Great Wall) M1-Gobi  (Mt. Terelj National Park / Gobi Desert) M-3 (Arhangai - Switzerland of Mongolia) Hong Kong Biking Day Tour (indicate tour date on rooming preference below) NZ1S (New Zealand Southern Alps!) NZ1S-Short (New Zealand Southern Alps!)

Do you have any physical requirements, history, or medication we should know about?

Do you have a rooming preference (e.g., roommate name, etc.)?

Do you wish to have single accommodations (with supplemental charge) ?

  Yes No

By clicking the box, I acknowledge and confirm that International Cyclists to Asia as operator of the tour(s) or any associated booking agents/land operators are released from any liability relating to the tour for which I am applying, either in injury, civil unrest, terrorism, illness or death. As well, International Cyclists to Asia will have no liability regarding the adequacy of medical care, equipment or supplies that may be provided. I also agree with the published Terms and Conditions outlined for my participation on this tour and have read the same.

*Acknowledge