Step 1 of 7 14% Tour Participant InfoName* First Last Phone*Please provide country code as wellEmail* Tour Location and Departure Date*Colorado September 2019Tuscany May 2020Agreement and ResponsibilityIn submitting this form, I acknowledge that I am aware of and accept the terms and conditions listed on the Tour Participation Agreement. I further acknowledge that I am in adequate physical condition for the tour I have selected. I have voluntarily applied to participate in this tour with the full understanding that bicycling and other tour activities involve risks and hazards that may involve injury and/or death. I affirm that I am in good health and adequate physical condition to undertake a tour such as this. I also acknowledge that I am responsible for my own medical and accident insurance, and for ensuring that it is effective in the country/countries I will be traveling to.I,*have read the disclaimer above and understood the Terms and Conditions outlined on the Tour Participation Agreement and understand the risks involved in participating in this trip.I have read and signed the Tour Participation Agreement* YES You must sign the Tour Participation Agreement in order to continue and to join a tour.VIEW Tour Participation Agreement DOWNLOAD Tour Participation Agreement Save and Continue Later Insurance NotificationI am fully aware that Intentionally Lost strongly recommends that all travelers purchase Trip Cancellation and Interruption insurance. I understand that it is in my best interest to purchase Trip Cancellation and Interruption Insurance and will take full responsibility for my choice should I decide not to purchase it. Required Coverage Accident & Sickness Medical Expense Coverage (minimum $100,000 USD) Emergency Evacuation & Repatriation of Remains (Minimum $200,000 USD) Accidental Death / Dismemberment Trip Cancellation CoverageI AGREE*Name, DateMedical or Dietary NeedsDo you have any medical needs or concerns we should be aware of?* No Yes Please explain your medical needs we should be aware of.*Do you have any dietary preferences or needs we should be aware of?* No Yes Be as specific as possible; we have found that some labels such as 'vegetarian diet' vary in definition by individual. If 'Yes,' please list foods you will not or cannot eat. (example: I do not eat mushrooms; I am allergic to shellfish; I do not eat any dairy products; I do not eat red meats; I cannot eat hazelnuts)Please explain your dietary preferences or needs.* Save and Continue Later Passport InformationBe sure to check that your passport won't expire within 6 months of your return date! Renewing Passport will send later (email passport information to firstname.lastname@example.org) Passport NumberIssuing CountryName as it Appears on PassportDate of Issue (mm/dd/yyyy)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Expiration Date (mm/dd/yyyy)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Date of Birth (mm/dd/yyyy)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Save and Continue Later Bike Selection & FittingRemember to bring your bike helmet. We require everyone to wear a helmet while on tour. If you forget your helmet or don’t want to travel with it, we will have one available for you. Bike make and model selections are specific by tour location. We always have a selection of late model road, hybrid and mountain bikes to choose from. Please indicate your preference and remember we will be riding an average of 70KM / 45miles per day.Bike Preference* Road Bike with drop handlebars Hybrid (Flat Bar Road) Bike with flat handlebars I am bringing my own bicycle: I understand that I'm responsible for transporting or shipping the bike to and from the tour and will cover any costs I incur in so doing. I must be able to assemble and disassemble my bike and have the tools and any spare parts necessary to maintain its operation. Bike FItting Measurements. Please list your height and SOH for our records even if you are bringing your own bike!*Your Height: please provide in inches or centimeters: Your Stand Over Height:*Stand Over Height (SOH): Please provide in inches or centimeters (To determine stand over height, stand barefoot on a hard floor with feet six inches apart. Then measure vertically from the base of your crotch to the floor. Please note that this is not the same as your pants inseam!):Are you bringing your own pedals?* Yes No We provide platform pedals or pedals with toe baskets. If you opt to bring your own clip-in/SPD shoes, you must bring your own pedals to use on tour. Your tour leaders will install those for you at the time of bike fitting.Would you like toe cages? Yes - with straps Yes - no straps No - flat pedals Bicycle Notes. If you have any additional notes or comments about your bike please let us know. Save and Continue Later Accommodations/Rooming PreferencesRooming Preference* I'm traveling independently and am willing to share a room. I'm traveling independently and I'd like my own room. I'll pay the Private Room Charge. I'm traveling with a spouse/companion (please list name of companion): Please list name of spouse/companionIf you are traveling with a spouse or companion, please select your bed preferences. One Bed (typically queen size) Two Twin Beds Save and Continue Later Travel ArrangementsTravel and Flight Information - In case Tour Leaders need to get in touch with you and know where you're at.Tour StartDate and time of arrival, airline flight number and arrival airportTour EndDate and time of departure, airline flight number and departure airportAnything else we should know?Hotel ArrangementsWe can assist you with reserving extra nights at your tour starting and/or ending hotels. If you've already made your own hotel arrangements, please provide the hotel name(s) and number of nights below. We are asking for this so Tour Leaders know how to get in touch with you, if necessary. The starting and ending hotels of your tour are specified in the tour itinerary emailed to you with your reservation confirmation.Extra nights at starting hotel? I have arranged my own extra night(s) at the starting/meeting hotel. Please provide hotel name and check in date here:Not staying at our starting hotel before the tour I am staying elsewhere for extra night(s) before the tour. Please provide hotel name and check in date here:Extra nights at ending/drop off hotel? I have arranged my own extra night(s) at the ending/drop off hotel. Please provide hotel name and check out date here: Save and Continue Later Emergency ContactEmergency Contact Information (someone who is not on tour with you)**Please include first and last name and relationship to youFinal NotesThank you for submitting your Customer Information Form. Please email us any missing information if you were not able to include it at this time. Email that information to email@example.com Please review packing lists on Intentionally Lost website. If there is anything you can’t do without then pack it and bring it with you. Don’t count on being able to purchase chamois cream, bike parts, shoe cleats, etc when you arrive in country. Let us know if we can assist you in any way!EmailThis field is for validation purposes and should be left unchanged. Save and Continue Later This iframe contains the logic required to handle Ajax powered Gravity Forms.