Name*
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City
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Zip/Postal code
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Work Phone
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E-mail*
What month do you plan to travel	March April May June July August September October
What year do you plan to travel	2010 2011
Destination	Ireland Italy France
Preferred Region	Connemara Burren West Coast Extra Burgundy Loire Valley Bordeaux Dordogne Languedoc Provence Tuscany Umbria Puglia Sardinia
Type of tour	Guided Self Guided Family Adventures Tailor Made
Type of accommodation	Castles & Manors Guesthouses (Inns) Villas in Italy Mixed selection
Bringing own bikes	Yes No
Number of children in group	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 0
Number of adults in group	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Cycling Experience	Beginners Intermediate Experienced Mixed beginners / intermediate Mixed intermediate/experienced
Anticipated arrival date in Ireland	-- mm/dd/yy
Anticipated departure date from Ireland	-- mm/dd/yy
Do you plan on additional travel in Ireland prior to, or following your bike tour?	Yes No
How many additional days?	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Would you like additional activities to be included as part of tour?	Yes No
Choose one of the following options:	None Horse riding Fishing Golf Spa & Health Walking Kayaking Surfing Archaeology Sailing Surfing Scuba Diving Surprise us!
Do you have any comments or suggestions to add that will assist us in planning your trip?