REGISTRATION FORM Please complete the form below and click the submit button to register. (Please esure all boxes are completed prior to submitting form) Name (Surname in Block Letters) Gender Male Female Nationality Passport Number Expiry Date (Day/Month/Year) Email Address Postal Address Landline Phone (country code/area code/number) Mobile Phone (country code/number) Date of Birth (day/month/year) LONG DISTANCE CYCLE TRIPS Number of trips (0, 1, 2 etc) Length of Trips(1, 2 etc) If you have not done any long distance trips place ‘o’ in the box. Trip 1 Trip 2 VISITS TO INDONESIA Number of visits (0, 1, 2 etc) Length of Visits (1, 2 etc) If you have not visited Indonesia place ‘o’ in the box. Visit 1 Visit 2 SUBMIT FORM Colin Freestone has the sole right to accept or reject applications (via submission of completed registration form) to participate in this trip and no correspondence will be entered into.

SITE LAST UPDATED: 13 October 2009

© Indonesian Cultural Communications
Phone: +612 9983 0205 | Email cycle_indonesia@bigpond.com.au

Site development: www.egnarodesign.com.au


cycle indonesia, indonesia cycle, cycle sulawesi, sulawesi cycle, cycle and yoga indonesia trips, indonesia cycle and yoga trips, cycle toraja, toraja cycle, cycle sulsel, cycle tour 2008, cycle south east asia, cycle asia, yoga south east asia, yoga and cycling, cycle asia, cycle south east asia, cycle indonesia, indonesia cycle, cycle sulawesi, sulawesi cycle, cycle and yoga indonesia trips, indonesia cycle and yoga trips, cycle toraja, toraja cycle, cycle south sulawesi, cycle tour 2009, ujung pandang, adventure cycle, exotic cycle tour, makassar, rantepao, makale, sengkang, bantimurung, enrekang, pinisi, bulukumba, bike friday, yoga and cycling, ubud, sanur, denpasar, nusa dua, cycling tour, cycle ubud, bali adventures, bali bike, bali safaris, my indonesia, balinese cycle, bicycle tour, bali.