Print this page and Fill it out.
Please print clearly or type the information for the HD BIKR Motorcycle TOUR you want to reserve.
Fill out all the information in the spaces provided. If additional space is needed, use the back of this form
or attach another sheet. If you have any questions concerning the information requested, please contact us.
Tour Name ___________________________________________________ Tour Date _____________________________
Rider ( ) Co-Rider ( )
Riders Name ________________________________________________________________________________________
Address _____________________________________________________________________________________________
City ________________________________________________ State ______ Zip ______________ Tee Shirt Size ______
Home Phone ( _____ ) _________________________________ Work Phone ( ______ ) _____________________________
Fax ( _____ )_________________________________________ Email ___________________________________________
Age____________ Occupation ___________________________________________________________________________
Drivers License # _____________________________________ State ________________ Expiration Date _____________
Years of Riding Experience _____________________________ Motorcycle Safety Course: YES ( ) NO ( )
Motorcycle Make _____________________________________ Year _____________ Model _________________________
Co-Riders Name _____________________________________________________________________________________
Address _____________________________________________________________________________________________
City ________________________________________________ State _______Zip ______________ Tee Shirt Size ______
Smoking ( ) Non-Smoking ( )
Special Needs: ( such as medical conditions, Allergies, medicine taken regularly,etc. ) ____________________________________________________________________________________________________
____________________________________________________________________________________________________
Emergency Contacts:
Name ______________________________________ Relationship ________________ Home Phone ___________________
Name ______________________________________ Relationship ________________ Home Phone ___________________
Motorcycle Insurance____________________________________________________ Phone ________________________
Health Insurance________________________________________________________ Phone ________________________
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