Marty Jemison Cycling Tours Reserveation Form

MJCT CYCLING TOURS RESERVATION FORM

You will need to provide the following information along with a $500 deposit.

Tour Name:

Tour Dates:

Last Name:

First Name:

Address:

City:

State:

Zip:

Phone Day:

Phone Night:

EMail:

Passport #:

Passport Exp:

Emergency Contact:

Phone Day:

Phone Night:

Traveling alone, find me a roommate?

Traveling together?
Name of Roomate:

Traveling alone? - I want my own room! Supplemental charges apply

	Are you in good physical condition? YES NO
	How much do you ride? (hours/mileage/experiences)
	What should we know about you?
	Why did you choose MJCT?
	Are you comfortable riding 50 miles per day? YES NO

Call me for my credit card number and expiration
I will fax my credit card number & expiration to 1.775.361.7367

We honor a 15 day recission on the deposit only