Clone of 2024 Group Tour Registration Form: June 30-July 14 -- Calais to Besançon

Registration and Reservation Form

Calais to Besançon group cycle tour, June 30-July 15, 2024. Please complete one per traveler
Name as you'd like it to appear on your name tag*

First NameLast Name
Email address*
example@example.com
Cell phone number*
Address*

Street Address

Street Address Line 2

CityState/Province

Postal CodeCountry
Rooming Preference*

SingleDoublePlease find me a roommate
Name of roommate (if applicable)

First NameLast Name
Name as it appears on your passport*

First NameMiddle NameLast Name
Passport number*
Place of birth*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Country where passport was issued*
Date passport became effective*

MonthDayYear
Date
Passport expiration date*

MonthDayYear
Date
Date of birth*

MonthDayYear
Date
Do you know of any health issues that may affect your ability to complete the itinerary?*

NoYes
If yes, please describe:
Are you being treated for any chronic condition that might affect your health on the tour? If so, please describe*
Emergency contact name*

First NameLast Name
Emergency contact relationship
e.g. sibling, spouse, friend, etc.
Emergency contact telephone number*
Emergency contact email address
example@example.com
Will you celebrate a birthday or wedding anniversary during the trip?

YesNoOther
If so, what is the date and the event?
e.g. birthday on mm/dd/yy, etc.
Terms and Conditions*
Signature: By signing this form you affirm that all the information included here is accurate and that you have read and understood the Terms and Conditions.

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Payment

June 30-July 14 -- Cycle Calais to Besançon€1,582.00

The total trip cost (per person double occupancy) is €4795.00, of which a 33% deposit of €1582.00 is required to reserve your place. The Single Supplement cost is €650.00. The balance and Single Supplement, if applicable, will be billed for payment 90 days before departure.

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Registration and Reservation Form