Costa Rica Cycling Adventure: REGISTRATION

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First Name *

Last Name *

Trip Dates *

November 28 - December 5, 2023

Street Address 1 *

Please provide complete street address. If more room is required complete Street Address 2.

Street Address 2

Please provide continuation of Street Address 1 if required.

City, State *

Please provide city and state of residence. State abbreviations acceptable.

Zip *

Please provide zip code of city and state of residence. 5 digit zip codes are adequate.

Email Address *

Please provide email address and double check for accuracy.

Phone Number *

Please provide complete phone number.

Alternate Phone Number *

Please provide complete phone number.

Emergency Contact Name & Phone Number *

Please provide responsible emergency contact name & phone number.

Comments

Please provide additional information as needed. For example, non-cycling spouse, roommate requests, etc.

Terms and Conditions/Liability Waiver *

I have read and agree to the Terms and Conditions and am electronically signing the RIDE APPLICATION WAIVER OF LIABILITY, ASSUMPTION OF RISK and INDEMNITY AGREEMENT.

Required

Travel Insurance Waiver *

Travel Insurance Waiver: I have been advised about the availability and the importance of obtaining travel insurance and have either applied or have waived purchasing such coverage.

Required

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