Select your trip
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Gender
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Name
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First Name
Last Name
Rider Type
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Phone
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Country
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Email Address
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Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Birthdate
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DD
YYYY
Do you want your own room?
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Single supplement applies
Traveling with others on this tour?
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Room type required
Name of roommate your traveling with
If traveling alone do you want us to find you a 'same gender' roommate?
If we are not able to find you a roommate, half single supplement will apply
Are you over 65 years of age or have a medical condition?
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If yes please provide details
Special dietary needs?
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If yes please provide details
Is there anyting else you would like to tell us about yourself?
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If yes please provide details
I acknowledge that there is a degree of difficult in cycling in mountainous regions and state that I am physically fit, have trained adequately and have sufficent cycling exprerience to participate in my selected trip:
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Emergency contact name
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First Name
Last Name
Emergency contact phone number
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Relationship to you
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PAYMENTS & CANCELLATION
A reservation is not confirmed until this form has been submitted and the FULL PAYMENT for the tour has been received.
PAYMENT: Due by 1st March 2020
CANCELLATION: If you cancel your confirmed Peloton Grand Tours booking, the following cancellation fees apply:
Twin Share $599.00
Double Room for single use $849.00
After: 1st March 2019 - Full payment will be forfeited
Deposit Payment by:
ACKNOWLEDGEMENT WAIVER & RELEASE
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I agree to comply with all road rules and regulations, and all lawful instructions and directions of Peloton Grand Tours (Australia), its directors, officers, employees, contractors, and volunteers (collectively the Organiser) during the Peloton Grand Tours organised tours (The Event). If I fail to comply with the road rules and regulations, and instructions and /or directions of the Organiser I will not bee permitted to ride or continue to ride.
I confirm that I will provide the Organiser with details of, or a copy of, my Travel Insurance Policy that covers my participation in a Peloton Grand Tours tour.
I confirm that I will have had my bike checked by a qualified bike mechanic before taking part in a Peloton Grand Tours tour.
I acknowledge that if the Organiser performs any repairs or work on my bicycle or other equipment the Organiser does not warrant that work nor offer any guarantee of any kind in respect of that work.
I acknowledge that cycling can be an inherently dangerous activity. I recognise that there are risks and hazards specifically associated with this activity, including the possibility or injury and death and loss ad damage both to myself and my possessions. I therefore release the Organiser o any liability resulting from injury, death, loss or damage during the Event.
I understand and acknowledge the dangers associated with the consumption of alcohol or ay mind-altering substance before or during any cycling activity. I accept full responsibility for injury, loss or damage arising from consumption of alcohol or any mind-altering substance.
If I suffer any injury or illness, I agree that the Organiser may provide evacuation, first aid and/or medical treatment at my expense and my acceptance of these terms and conditions constitutes my consent to such evacuation, first ad and/or medical treatment.
I acknowledge that I have sole responsibility for my personal possessions and sporting equipment during the Event.
I agree to the Organiser using images of me taken during my participation of the Event for promotional purposes.
For myself, my executors, administrators, heirs, next-of-kin, successors and assigns, I hereby:
(a) waive and release all claims I may have against the Organiser or any one or more of their executors, administrators, heirs, next-of-kin, successors and assigns including any or all claims for injury, loss or damages caused by negligence of any of the above arising out of my participation in the Event, associated travel or sightseeing activities together with any costs including legal fees that may be incurred as a result of such claim whether valid or not; and,
(b) indemnify and hold harmless the releases and each of them against any such claim that I or any one or more of my executors, administrators, heirs, next-of-kin, successors and assigns may have or assert and against any cots including legal fees with respect thereof; and
(c) Acknowledge that if I were to assert a claim such clim would be subject to the exclusive jurisdiction of the laws of New South Wales, Australia. I acknowledge that I have read this assumption of risk. I fully understand its terms and that I have given up substantial rights by agreeing to it. I accept this document freely and voluntarily without any inducement made to me and intent my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law.
I accept / agree to the Waiver & Release conditions by clicking yes below
