"Free Wheeling" Reservation Form

It's time for a "Free Wheeling" adventure, so please check to see if the
Harley and hotels are available for the following tour and dates.  I (we)
have read, and agree to, the Terms and Conditions/Waiver Agreement
and all of its provisions.

NOTE:  Make travel plans so you can begin riding by 1pm on the first day,
you will finish riding by noon on the final tour day.  Your "Free Wheeling" reservation request must be for a tour date at least 45 days in the future.  Ten percent surcharge for a tour less than 45 days from now.

Fields marked with * are required information

Name*
Street Address
City/State/Country/Zip
Daytime Phone
Evening Phone
Fax
E-mail*
Date of Birth*	Male Female
Motorcycle License Number*
Place of Issuance*	Expiration Date*
Riding with a companion?*	Yes  No
Companion on cycle with you?*	Yes  No
Companion sharing rooms?*	Yes  No
Companion's name

NOTE:  If your companion will be riding a separate cycle by themselves, they need to fill out their own Reservation Form.  
NOTE:  If two of you want to ride separate cycles but share hotel rooms, each can deduct $150 from the 4-day tour rate or $200 from the 5-day tour rate.

Where and when is your requested "Free Wheeling" Tour:

Length of tour* (NOTE: Pick up Harley at 1pm on first day, return before 1pm on last day)	4-day (3-night) Free Wheeling 5-day (4-night) Free Wheeling
City choice*	Pick your Free Wheeling Tour From Las Vegas From Phoenix From Orlando From New Orleans From San Diego From Miami
Start date*	(mm/dd/yyyy)
End date*	(mm/dd/yyyy)
Harley model*	Sportster Dyna Heritage Softail Fat Boy Road King Electra Glide Pick your choice of rental Harley
Rooms with one bed or two?	One Two
Your travel agency
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