     Online Registration Form

Tour Registering for:



Personal:

First Name:

Last Name:

Address:

City:

State/Province:

Zip/Postal Code:

Country:

Home Phone:

Business Phone:

Cell Phone:

Fax:

E-mail:

How did you find us?
(Please list friend, family, publication, search engine, etc.)

If "other," please identify:

Cyclist Profile:

Age:            Male    Female

Profession:

Married:   Yes    No

     Does Your Spouse Cycle?    Yes    No

Children:     Yes    No

     Ages:
     Do they Cycle? Yes    No

Average miles per week:
     Self:
     Family:

Do you belong to any Cycling Clubs: Yes    No

    Which ones?

# of Centuries in 2005:

# of Cycling Tours since 2003:

Destinations:

Prefer:   Road   Mountain Both

Cyclist Registration Information:

Room Occupancy:   Double Single

     Partner Name:
     Gender:          Male  Female
     Age:

Transportation needed to/from Montrose Airport? Yes    No

Average miles training per week for this tour:

Dietary Restrictions:

Medical Conditions or Allergies we should be aware of: Yes   No
     If Yes, Specify:

Emergency Contact Name:
Relationship:
Phone:       Alternate Phone:
Address:

Reservation for 50 minute massage in Durango? Yes  ($60.00)  No

Shirt Size:

Men:          Small          Medium         Large        X-Large

Women:    Small (10)    Medium (12)     Large (14)

Comments or Questions: