RESERVATION FORM

ASSOCIAZIONE ABCYCLE - 38, C.da Brecciano - 65013 CITTA' S.ANGELO (PE) Italia TEL/FAX (+Italy) 085/969410 - abcycle@virgilio.it

(please print)
NAME
DATE/PLACE OF BIRTH                       
ADDRESS
CITY
STATE/COUNTRY
ZIP CODE
E-MAIL
PHONE/FAX
TOUR/DATES
ROOM REQUESTED      Single [ ]   Double [ ]
DEPOSIT
BALANCE
JERSEY SIZE    S   M  L  XL  XXL

EMERGENCY CONTACT:

PLEASE WRITE BELOW ANY INFORMATION WE SHOULD KNOW RELATED TO YOUR MEDICAL CONDITIONS, FOOD ALLERGIES,  DIETS, ETC.

I CONFIRM THAT I HAVE READ, FULLY UNDERST00D AND ACCEPTED THE CONTENT OF THE "RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT" AND I AM FULLY AWARE THAT BY SIGNING THIS APPLICATION FORM I AM WAIVING CERTAIN LEGAL RIGHTS WHICH I OR MY HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS, ASSIGNS AND PERSONAL REPRESENTATIVES MAY HAVE AGAINST THE RELEASEES.

 Date_______                                                     Sign   _______________________