Barossa Classic Cycle Tours


		Online Booking Form

	Address and Contact Details
	Flat / Unit number:
	Street number:
	Street:
	Suburb:
	Post code:
	State / Provence:
	Country:
	Age:
	Occupation:
	Home Phone:
	Mobile Phone:
	Email:

	Emergency and Special Req.
	Emergency Contact Name:
	Emergency Contact Number:
	Details of any medical conditions

	Details of any special dietry needs
	I would like to room with
	Room type		Twin Double
	I will be riding a		Road bike Hybrid Tandem MTB Recumbant

	How did you hear about this tour?		Web Magazine Ad Brochure Poster Bike Shop Bike Ride SA Tourism Other

	Jersey Size		S M L XL XXL
	Do you have ambulance cover?		Yes No
	Do you have private health or personal accident insurance cover?		Yes No

	Optional Extras
	I require Transfer		Yes No
	Number required from Adelaide
	Number to Adelaide
	Enter total Transfer cost
	I require extra night accommodation before start		Yes No
	I require extra night accommodation after finish		Yes No
	Extra nights		Enter number of nights x Enter extra night cost
	Enter total extra night cost (number of nights x extra night cost)
	Extra jersey		S M L XL XXL
	Enter total jersey cost

	Payment Details
	Total Tour Cost
	To confirm Booking a Deposit of $200 is required.		See Terms & Conditions
	I am paying		Deposit $200 Full Amount Balance
	Enter Amount
	Payment details		Visa Mastercard Bankcard Cheque MoneyOrder
	Card holders name
	Credit card details(number)
	Expiry date

	I have read and agree to the terms and conditions		Yes

	A receipt will be forwarded to you.		Choose Print from the Main Menu to print this form
			Choose Close from the menu to return to the web site.

Online Booking Form