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Registration Form

Registration

	Personal Information
First Name (*)	Invalid Input
Last Name (*)	Invalid Input
Address (*)	Invalid Input
City (*)	Invalid Input
State (*)	Invalid Input
Zip/Post Code (*)	Invalid Input
Work Phone (*)	Invalid Input
Home Phone (*)	Invalid Input
Cell Phone	Invalid Input
Fax	Invalid Input
Email (*)	Invalid Input
Are You a Cyclist or Non-Cyclist?	Invalid Input
	Main Contact - Arrival Information
Arrival Date at YCI	Invalid Input
Arrival Airline	Invalid Input
Arrival Flight Number	Invalid Input
Flight Arrival Time at Airport	Invalid Input
I Want Airport Pick-up	Yes No Invalid Input
If Yes, Which Airport (Taxi Fee Will Apply)	Invalid Input
Estimated Arrival Time at YCI (By Car or Train)	Invalid Input
	Main Contact - Departure Information
Departure Date From YCI	Invalid Input
Departing Airline	Invalid Input
Departing Flight Number	Invalid Input
I Want Airport Drop-off	Yes No Invalid Input
If Yes, Which Airport(Taxi Fee Will Apply)	Invalid Input
Departure Time from YCI (By Car or Train)	Invalid Input
	Accomodations:
I Will Room with Another Cyclist or non-cyclist:	Yes No Invalid Input
If Known, Please State Name	Invalid Input
	Note: All rooms are for two persons, in the instance of children, an additional bed can be supplied
I Wish to Have a Single Room (Note: 25 Euro per Day Extra)	Yes No Invalid Input
	Health & Emergency Contact
Do you have any medical conditions that put you at risk?	Invalid Input
In case of an Emergency, Please Notify:	Invalid Input
Daytime Phone	Invalid Input
Cell/Mobile Phone	Invalid Input
	Rider Information
How Many Years Cycling?	Invalid Input
I am Interested in the Following Ride Catagory:	Invalid Input
Are You Currently a Competitive Cyclist?	yes no Invalid Input
If so, What Discipline?	Invalid Input
	Bicycle Information
I Will Bring My Own Bicycle	Yes No Invalid Input
I Will Rent an Italian Bicycle	Yes No Invalid Input
	If renting an Italian bicycle please provide the following information
My Height (cm)	Invalid Input
My Inseam (cm)	Invalid Input
My Bicycle Top Tube (cm)	Invalid Input
My Current Frame Measurement (cm)	Invalid Input
My Stem Length (cm)	Invalid Input
Saddle to Handle bar Reach (Tip of Saddle to Center of Stem cm)	Invalid Input
	Daycare
I am Interested in Daycare (Daycare Fees Apply)	Yes No Invalid Input
For How Many Children/Infants	Invalid Input
What Ages	Invalid Input
	Liability Waiver & Agreement
Agreement	RESPONSIBILITY, RELEASE OF LIABILITY, ASSUMPTION OF ALL RISKS, AND ARBITRATION AGREEMENT YOURCYCLINGITALIA (dba yourcylingitalia.com and referenced as "YCI") requires all participants in the bicycling program (referenced the "Program") conducted by YCI sign this Responsibility, Release of Liability, Assumption of All Risks, and Arbitration Agreement (the "Agreement") as a condition of their attendance at the Program and participation in Program activities. I acknowledge that the enjoyment and excitement of adventure travel is derived in part from the inherent risks incurred by travel and activity beyond the accepted safety of life at home or work and that these inherent risks contribute to such enjoyment and excitement, being a reason for my participation. I am voluntarily participating in this Program with the knowledge of the numerous risks and dangers involved, including but not limited to: negligence or gross negligence in any manner on the part of YCI including, without limitation, in the conduct or arrangement of the Program in any respect from inception to completion, with regard to bicycle selection or maintenance, in the maintenance or operation of any van or other motor vehicle utilized to transport passengers, etc.; physical exertion for which I am not prepared; forces of nature and acts of God; transportation failures whether by plane, train, auto, bus, bicycle, by foot, or by any other conveyance; consumption of alcoholic beverages; civil unrest; terrorism; criminal activity; breakdown or failure of bicycles or other equipment; high altitude; accident or illness without access to means of rapid evacuation or availability of medical supplies or services; the adequacy of medical attention once provided; and stolen, lost, or misplaced luggage or property. It is acknowledged and understood that the cost of YCI Program is partly based upon Program participants executing this Agreement. Therefore, as lawful consideration for being permitted to participate in such Program(s), I hereby RELEASE AND DISCHARGE FOREVER YCI FROM AND AGAINST ANY AND ALL LIABILITY ARISING FROM MY PARTICIPATION IN THE PROGRAM, INCLUDING NEGLIGENCE AND GROSS NEGLIGENCE AND I ASSUME ALL RISKS AND DANGERS, INCLUDING WITHOUT LIMITATION, RISKS OF DELAY, UNANTICIPATED EVENTS, INCONVENIENCE, ILLNESS, INJURY, EMOTIONAL TRAUMA OR DEATH AND FULLY RELEASE YOURCYLCING ITALIA from any and all liabilities to the maximum extent permitted by law.. I agree that this release and discharge shall inure to the benefit of YOUR CYCLING ITALIA its employees, shareholders, subsidiaries, affiliates, officers, directors, successors, agents, and assigns. I further agree that this release shall be legally binding upon me personally, all members of my family and all minors traveling with me, my and their heirs, successors, assigns, and legal representatives, it being my intention fully to assume all the risks associated with this Program and to release YCI from any and all liabilities to the maximum extent permitted by law. I further acknowledge and understand that employees or agents of YCI may provide me with maps, geographic and/or other directions during my participation at Program and I agree to follow such directions; however, YCI does not make and expressly disclaims any representations or warranties with respect to the condition or safety of the roads on which the cycling activities may participate. I acknowledge and assume sole responsibility for observing such road and other conditions and determining whether I have a mechanically fit bike as well as the requisite skills, conditioning, and that I am able to ride or race my bicycle safely in light of such conditions. I further understand and acknowledge that no employee or agent of YCI may be delegated, or is authorized to accept or assume, any of the responsibility(s) which I may have in connection with making such determinations. In addition, I acknowledge and understand that I am responsible for the maintenance and safe condition and operation of my bicycle(s) and related equipment while attending the Program. This includes any bicycle or other equipment that I rent from any third party, including any third party to whom YCI has referred me. No such third party is an agent or employee of YCI but, instead, is an independent contractor and YCI has no responsibility or liability for the acts or omissions of such third party. As an express condition of participating in Program, I have or will have an ANSI or SNELL approved helmet at the Program and I will wear the helmet at all times when engaging in all cycling activities. In that connection, I have been further advised and acknowledge that I am responsible for providing my own insurance while attending the Program as well as ensuring that such insurance covers my activities as well as being effective outside the United States of America. As a matter of convenience, YCI may reference or provide links to certain carriers but makes no endorsement whatsoever with respect to the carriers, including the suitability of the carriers or coverage. YOUR CYCLING ITALIA its employees, shareholders, subsidiaries, affiliates, officers, directors, successors, agents, and assigns does not own or operate any entity which provides, or is to provide, goods or services for your Program including, without limitation, lodging facilities, transportation companies, food service providers, bike rental and other equipment suppliers, bike repair shops, and similar operations. As a result, such third parties are an independent contractors and YCI shall not be liable for any negligent or willful act or omission of any such third person, or of any other third party. BINDING ARBITRATION: I agree that any dispute concerning, relating, or referring to this contract, brochures, website, or any other literature concerning the Program or the Program itself, shall be resolved exclusively by binding arbitration according to the then existing rules of the American Arbitration Association in Boston, Massachusetts, to the exclusion of the Courts of all other states or countries. Such proceedings will be governed by Massachusetts substantive law and a three person arbitration panel, one panel member chosen by plaintiff, one by the defendant and one jointly chosen. MISCELLANEOUS MATTERS: I understand that YCI reserves the right to take photographic or film records of any of its Program and hereby agree that YCI may use any such photographic or film records for promotional and/or commercial purposes, as well as approve such use by third parties with whom YCI may engage in joint marketing, without any remuneration to me. I hereby assign all right, title, and interest I may have in or to any and all media in which my name or likeness might be used by YCI. I understand that YCI reserves the right to refuse as a Program participant, or remove from a Program, any person, which, in its sole discretion, it judges to be incapable of meeting the rigors and requirements of participating in the activities or who it determines to detract from the enjoyment of the Program by others. YCI reserves the right to make route, hotel and Program modifications as required or desirable to improve the Program quality and/or to accommodate the comfort and well-being of guests. YCI further reserves the right to correct or increase the program price in the event of cost increases due to currency fluctuations or other matters outside the control of YCI. KNOWING AND VOLUNTARY EXECUTION: I have carefully read and fully understand the contents and legal ramifications of this Agreement as well as all other terms and conditions as stated in the current YCI brochures and/or website. CANCELLATION FEES: If I must cancel my reservation, my cancellation fee will be as follows: 1) At the time the reservation is made, you must forward a completed reservation form, an executed original of this Agreement along with a minimum deposit of $150.00 USD per person. On acceptance of the reservation, this deposit shall become NON-REFUNDABLE. 2) All cancellations must be in writing, including email. If I cancel my reservation, the deposit will be applied towards a subsequent stay within one year from the date of the original booking or the deposit is forfeited. Exceptions to this policy cannot be made for any reason. LEGAL EFFECT and SEVERABILITY: I understand that this is a legally binding and enforceable contract and release and sign it of my own free will. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions shall remain in full. Signature of Applicant: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Printed Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Date . . . . . . . Signature of Parent or Guardian, if minor: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Printed Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Date . . . . . . . Invalid Input
	By entering "submit" you are affirming that you have read and that all parties agree to the terms of our Liability Waiver and Agreement.
Submit

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