Tour name and date
Tour Name:
A value is required. *
Date of Tour:
A value is required. *
Number of people:
A value is required. *
Customer # 1
Complete name:
A value is required. *
Gender:
Street address:
A value is required. *
City:
A value is required. *
State / Province:
A value is required. *
Zip / Postal code:
A value is required. *
Country:
A value is required. *
Telephone (home):
A value is required. *
Telephone (work):
A value is required. *
Fax:
email:
A value is required. *
Bike Rental
I will be renting a bike:
*
Bringing my own bike, rental not required:
*
Your height:
If renting a bike, please specify model
Will you be bringing your own pedals?:
If we provide the pedals, do you prefer normal pedals or pedals with toe clips?:
Any special considerations
Accommodations
Type of room requested:
*
*
*
*
If you are paying for a single room, please specify the type of bed:
If sharing room,
If you are registering more passengers to this tour, please fill out each field below for each customer. If there are more than 4 passengers in your group, please fill out a second form (by returning to the tour´s webpage, and clicking the “Reserve your Space” button). Otherwise, if you have finished your registration for this tour, you can finish your reservation by clicking here
Customer # 2
Complete name:
*
Gender:
Street address:
*
City:
*
State / Province:
*
Zip / Postal code:
*
Country:
*
Telephone (home):
*
Telephone (work):
*
Fax:
email:
*
Bike Rental
I will be renting a bike:
*
Bringing my own bike, rental not required:
*
If renting a bike, please specify model
Your height:
Will you be bringing your own pedals?:
If we provide the pedals, do you prefer normal pedals or pedals with toe clips?:
Any special considerations
Accommodations
Type of room requested:
*
*
*
*
If you are paying for a single room, please specify the type of bed:
If sharing room,
Customer # 3
Complete name:
*
Gender:
Street address:
*
City:
*
State / Province:
*
Zip / Postal code:
*
Country:
*
Telephone (home):
*
Telephone (work):
*
Fax:
email:
*
Bike Rental
I will be renting a bike:
*
Bringing my own bike, rental not required:
*
Your height:
If renting a bike, please specify model
Will you be bringing your own pedals?:
If we provide the pedals, do you prefer normal pedals or pedals with toe clips?:
Any special considerations
Accommodations
Type of room requested:
*
*
*
*
If you are paying for a single room, please specify the type of bed:
If sharing room,
Customer # 4
Complete name:
*
Gender:
Street address:
*
City:
*
State / Province:
*
Zip / Postal code:
*
Country:
*
Telephone (home):
*
Telephone (work):
*
Fax:
email:
*
Bike Rental
I will be renting a bike:
*
Bringing my own bike, rental not required:
*
Your height:
If renting a bike, please specify model
Will you be bringing your own pedals?:
If we provide the pedals, do you prefer normal pedals or pedals with toe clips?:
Any special considerations
Accommodations
Type of room requested:
*
*
*
*
If you are paying for a single room, please specify the type of bed:
If sharing room,
Payment Instructions
To reserve your place in our tour, we require deposit of 30% of the tour pricesee below ). Reservations are made on first come – first served basis.
Payment amount:
U$
A value is required.
Payment via Paypal
Transfer funds to the account name: anibalmarasi@dirtybikes.com.ar * Please be sure to reference your deposit with your name
Payments in Argentina
Banco Galicia - sucursal Bariloche, cuenta # 873/8031/5
Pay to the order of / a nombre de: - Anibal Daniel Marasi (CBU 007031320000000873853, CUIT 20-22251334-1)
Final Confirmation
Before confirming your reservation and payment, please read our Terms and Conditions . By submitting this reservation form, you acknowledge to have read and accepted our Terms and Conditions
(please note that we also require you print and sign these T&Cs before the start of the tour).
I accept the Terms and Conditions for my participation in this tour
Please make a selection.
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