CBT Adventure Travel Application

Complete this application and send it to: CBT Adventure Travel, P.O. Box 27640, San Francisco, CA 94127 USA or Fax to 415.704.3256

(Note: State name as it appears in passport)

Last Name _______________________________ First Name _______________________________ 

MI _______Male ______ Female ______ Date of Birth - Month ______ / Day ______ / Year ______

Citizenship____________________

Address______________________________________________ Apt. # __________

City________________________________State/Province ____________ Zip/Postal Code ____________

Country ____________Phone (day) ______________________ Evening ______________________

Email ____________________________________

Passport number: ________________________________ Expiration: _________________________

Emergency Contact:

Address______________________________________________ Apt. # __________

City________________________________State/Province ____________ Zip/Postal Code ____________

Country ____________Phone (day) ______________________ Evening ______________________

Email ____________________________________

Shirt Size:

Men’s: _____  Women’s: _____

Circle Size: XS,  S,  M,  L,  XL,  XXL

Trip Choice(s)

1. Tour Name ___________________________________________________

Date(s)_________________________________

2. Tour Name ___________________________________________________

Date(s)_________________________________

Roommate Preference - Are you registering with a: ___ Friend ___ Spouse or ___ I’m a Single Traveler

Do you want to share a room? ___ Yes or ___ No

Separate Beds? __ Yes or __ No

Please list your roommate preference - if any: ____________________________________________

Do you desire a single supplement (limited numbers per trip)? ___ Yes or ___ No

Bicycle Rental - See each tour description for exact price.

___Yes, I would like to rent a hybrid-style bicycle.

My height is: ____________ My inseam is: _____________

Please also note that we cannot guarantee rental availability for requests made after

April 15, 2008

How did you hear about CBT?

Newspaper or Magazine - which one? ______________________________________________

Internet – Google, Yahoo, other ? _______________________________________

Friend or Relative - Name _________________________________________________________

Other - Please specify _____________________________________________________________

Have you ever been on a biking trip? If yes, with which organization? ______________

________________________________________________________________________________

Do you have any disabilities or medical concerns? If yes, please describe: _________

____________________________________________________________________________________

_____________________________________________________________________________

Do you have any dietary restrictions? If yes, please describe: ____________________

____________________________________________________________________________________

____________________________________________________________________________

CBT Adventure Travel Application

Payment:

___ Personal Check (payable to CBT)

___ Visa

___ MasterCard

Card Number: _____________________________________________ Exp. Date _________________

Signature ________________________________________________________________________

You have enclosed or provided each item to be sure that your application is complete.

1. This application form, all parts, fully-completed and signed.

2. If applying before March 30, a $250 deposit is required, the balance being due March 30.

3. If applying on or after March 30, your total tour cost

Participant Agreement

I have read and agree to all the “Terms and conditions” stated in this brochure, I hereby release CBT Adventure Travel and its agents of any and all responsibility and liability of any nature whatsoever for any loss or damage of property, or personal injury occurring on this or any other trip under its management in which I participate, for which CBT Adventure Travel cannot be reasonably held responsible. I also understand that a release form will be sent to me to be signed before departure.

Signature of Participant

________________________________________________________________________________

Signature of Parent or Guardian | if participant is under 18

________________________________________________________________________________