Costa Rica Cycling Adventure: REGISTRATION

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

First Name *

Last Name *

Trip Dates *

NO CURRENT TRIPS PLANNED: SEE RIDE SCHEDULE

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

Submit

Clear form

Never submit passwords through Google Forms.

Forms

This content is neither created nor endorsed by Google.