Holy Land Ride for Hearts - Registration

Personal Information
First Name:
Last Name:
Passport Number:
Date of Birth:
Gender:	MaleFemale
Contact Information
Telephone Number:
Mailing Address:
State/Province:
City:
Country:
Zip/Postal Code:
E-mail Address:
Tour Package Information
choose your rooming preferences
Double occupancy, 1 Queen Size Bed - I already have a roommate Double Occupancy, 2 Double beds - I already have a roommate Double occupancy - I don't already have a roommate but would like to be assigned one Single occupancy -I understand an additional charge applies
If you already have a roommate to share your room with, please state his/her name here
Additional Services
Bike rental
	I would like to rent a road bike for the tour (400$ Net per person)
Please specify your height
Additional Comments: (your inquiry will be answered by a Genesis Cycling or Holy Land Ride for Hearts staff member within 48 hours)

	I have read and accepted the Terms and Conditions
Total Price:

	Base package price is $1,200 if payment received on or BEFORE April 30th; $1,400 USD after April 30

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