CycleItalia Reservation Form Self-Guided Tours

2010 Self-Guided RESERVATION FORM

Please mail this completed form with your deposit to:
CYCLEITALIA P.O. Box 1386 Sioux City, IA USA 51102
www.cycleitalia.com
Phone toll-free (877) ITALBIKE (482 5245) Fax (712) 258-1776
e-mail: larry@cycleitalia.com

Name_________________________________________________________________________

Address_______________________________________________________________________

City, State, Zip__________________________________________________________________

Phone (daytime)__________________________Phone (evening)___________________________

e-mail_________________________________

persons traveling with you

1. Name_______________________________________________will room with____________

2. Name_______________________________________________will room with____________

3. Name_______________________________________________will room with____________

4. Name_______________________________________________will room with____________

5. Name_______________________________________________will room with____________

Tour Choice

[ ] Taste of Piedmont [ ] Taste of Tuscany

Tour Starting Date (date you will arrive at HQ hotel)

day_________ month_____________ year________

Deposit & Payment

Please include deposit (personal check, money order AND credit card authorization) of
$500 per person, per trip. (Minimum two persons)

Please review special self-guided cancellation policies prior to mailing your deposit. CycleItalia will mail you complete pre-trip planning information with your initial confirmation package. Final confirmation details with hotel lists, phone/fax numbers, maps, cue-sheets, etc. will be mailed 30 days prior to your departure.

I certify those listed above will be the only persons traveling with me and I agree to be responsible for them while on the vacation. Persons not listed on this form will not be permitted to participate in this vacation package in any way without prior authorization of CycleItalia, LLC. I agree to pay in full any additional amounts charged to my credit card for the participation of unauthorized persons or damage caused to property of CycleItalia or its hotel or restaurant partners.

Signature____________________________________________ Date_________________________