Epic Trippers 2012 Booking Form

To reserve your Epic Trippers place for the 2012, please complete the form below and submit your credit card details. Please download our credit card authorisation form
(you will need to complete this credit card form and fax it to us on +27(0)21-5114768).

Tour Date :	21March - 28March2009
Full Name :
Email :
ID or Passport Number :
Tel ( Home ) :
Tel ( Work ) :
Tel ( Cell ) :
Emergency Contact
Details of any Medical Conditions
Details of Medical Insurance :
Special Dietary Requirements :
If you are part of a couple do you prefer a double bed? :	Yes No
Would you prefer a single room?	Yes No
Do you require mountain bike rental?	Yes No
If so please indicate SIZE OF BIKE	Small Medium Large
Do you require a helmet?	Yes No
If so pls indicate SIZE	S M L XL
Cycle shirt size	XS S M L XL XXL XXXL
Comments or Enquiry's
Security Code