Submit Method Internet Fax/Mail

	Please Fill in empty fields with None or N/A

	Please fill out and submit this form, or you may also print, fill out, and mail or fax this form to:
	HARSAN Inc. Ste. 902-5790 Patterson Avenue Burnaby, B.C. V5H 4H6 CANADA Tel:(604) 788-2618 Fax:(604) 433-2369

First Applicant Name & Address

Passport Number

Date of Issue

Birthdate

Telephone Number(s)

Day

Evening

Fax

E-Mail

Second Applicant Name & Address

Passport Number

Date Of Issue

Date Of Birth

Telephone Number(s)

Day

Evening

Fax

E-Mail

	Tour & Departure Dates

Tour Name:

Departure Date:

	Accommodations

We are traveling togther and would like:       One double bed       Two twin beds       I am traveling alone and would like to share a room.       I would like a single room. (single supplement applies)

	For Bike Tours

I/We will bring # of bikes

I/We would like to rent # of bikes.

	Party 1:

Road Bike       Men's Hybrid       Women's Hybrid       Tandem

Bike Size

Your Height

Inseam

Toe Clips: Yes

Own Helmet       Need to rent a helmet       (Small)       (Large)

	Party 2:

Road Bike       Men's Hybrid       Women's Hybrid       Tandem

Bike Size

Your Height

Inseam

Toe Clips: Yes

Own Helmet       Need to rent a helmet       (Small)       (Large)

	For Day Tours:

City Of Pick-up:

Hotel Name:

Hotel Address:

Hotel Telephone:

	Payment
	Please make certified cheque payable to: HARSAN Inc. We also accept Visa & Mastercard. Mail to: Ste. 902-5790 Patterson Avenue, Burnaby, B.C. V5H 4H6 CANADA

	Agreement
	I/We have read and agree to the terms and conditions set forth by HARSAN Inc. In addition, I/we understand that a waiver will be sent and must be signed by each participant.

Please Type I agree or I do not agree below: