Photo copy this application for your records
Registration Application
$300 nonrefundable deposit required
Final Payment due September 1st, 2001
Date ____________ T-Shirt Size _____ Jersey Size * _____
*You will receive a Special Andes to the Amazon Cycling Jersey only if your register before Aug. 1, 2001
Name ______________________ Age _____
Street Address _________________________
City ________________________ State ______________ Zip _______
Country ___________
Best Phone ______________________
e-mail ______________@ _______________
| "X" The Tours and Services You are Registering For | Total | ||
| 10 Day Cycling and Riverboat Andes to the Amazon Tour | $1,695 | ||
| 5 Day ...Cuzco - Machu Picchu Tour | $895 | ||
| 8 Day ...Inca Trail - Machu Picchu Tour | $1,595 | ||
| Additional Options: | |||
| Bike Rental $50 per day (6 days) | $300 | ||
| Backpack transport on the Inca Trail Hike (8 day tour) | $80 | ||
| Extra hotel night in Lima ...extra day after tour ends | $60 | ||
| Single private room (per hotel night) | $55 x ____ | ||
| Single room Machu Picchu Hotel night | $125 extra | ||
| Grand Total | |||
262-736-2453 pacinfo@pactour.com
We need a copy of your insurance card:
_______Tape Insurance Card Here_________