Pacific Cycle Tours
Online Booking Confirmation Form

Please complete all fields. Once your booking form is submitted we will receipt your trip payments and confirm your booking.
Required fields are marked with an asterisk (*).

TOUR INFORMATION


(tour)*

(departure date [dd/mm/yy])

(accommodation preference)*
Names MUST be exactly as they appear in your passport.

(first name)*

(middle names)

(surname)*

(address 1)*

(address 2)

(city)*

(state)

(country)

(postcode)

(preferred contact method)*

(e-mail)*

(mobile phone)

(work phone)

(home phone)

(gender)*

(age)*

(height [cm])

(weight [kg])

PASSPORT DETAILS


(passport number)*

(issue date [dd/mm/yy])

(expiry date [dd/mm/yy])

(nationality)*

(date of birth [dd/mm/yy])*

(place of birth)

(occupation)

If you have booked your own flights, please enter details below


(arrival city)

(arrival date [dd/mm/yy])

(arrival flight nr.)

(arrival time [hh:mm])

(departure city)

(departure date [dd/mm/yy])

(departure flight nr.)

(departure time [hh:mm])

BIKE HIRE

If you will be hiring a bike from Pacfic Cycle Tours, please fill out the details below.

(cycling experience)
Inseam Length in cm without shoes
(stand against a wall in bare feet, put a ruler between legs and mark the upper end on the wall, measure from the floor to the mark = inseam length)

(inseam length in cm without shoes)

(flexibility)

(extra requirements)

(indicate any parts you will bring yourself)

HEALTH PROFILE

This profile is compiled to assist us in the care and wellbeing of all participants. The more detail we have the better we can look after you in an unforeseen emergency!

(dietary requirements)

(injury history)

(medical history and medication)

EMERGENCY CONTACT


(next of kin)*

(next of kin home phone)*

(next of kin work phone)*

(next of kin address)

TRAVEL INSURANCE

We strongly recommend the use of a travel insurance package.
We recommend Travelsure

Please put your travel insurance details here:

(insurance details)

 

Terms and Conditions

 

Please check this box to confirm you understand and accept the Terms & Conditions as stated above.
I acknowledge and confirm that I have read, understood and agree to all the booking conditions as shown above (parent or legal guardian must complete form for all persons under the age of 18)