"Free Wheeling" Reservation Form

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 Ride America Terms and Conditions and all of its provisions.

NOTE:  Your "Free Wheeling" reservation request must be for a tour date at least 60 days in the future.

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.  

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

Length of tour* (NOTE: You pick up Harley noon on first day and return before noon on the last day - except for Monument Valley Tour)	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 San Diego Las Vegas to Monument Valley
Start date*	(mm/dd/yyyy)
End date*	(mm/dd/yyyy)
Harley model*	Pick your choice of rental Harley Sportster Dyna Low Rider Heritage Softail Road King Electra Glide
Rooms with one bed or two?*	One Two
Your travel agency
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