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ExpeditionPlus! Application

1. Applicant Information

First Name *This question is required.

Last Name *This question is required.

Title

Company Name

Street Address

Apt/Suite/Office

City

State

Postal Code

Country

Email Address *This question is required.

Phone Number *This question is required.

Fax Number

Mobile Phone

URL

2. Why are you interested in this trip?

3. What are your hobbies (other than cycling) - are you a birdwatcher, photographer, geologist, chocolate connoisseur, etc.

4. Have you traveled with ExperiencePlus! before? If so, which tours?

5. ExpeditionPlus! tours vary significantly from our regular bicycle tours, are you aware of these differences? (to see a description of how they differ please click here)
*This question is required.

6. What bike touring have you done besides those described above with ExperiencePlus!?

7. What other international travel have you undertaken and in what countries?

8. What's the longest bicycle tour you've ever taken (number of days? total distance? longest single day ride?)

9. Please tell us about any regular physical activities you undertake or your exercise program.

10. Please tell us about your general health and any medical problems you have or that may arise.

11. Do you have any dietary restrictions, allergies or related medical conditions?

12. Do you consider yourself a bicycle mechanic?

13. Please check the following bicycle skills you do have.

Patch a tube
Change a tube
Adjust a derailleur
Adjust a brake
Replace a chain
True a tire

14. What bicycle do you currently ride?

15. Do you maintain your bicycle or does someone else?

16. How did you hear about this tour?

I am a long-time Expedition participant
Google search
Social Media (Facebook/Twitter)
A friend Please enter an 'other' value for this selection.
Other Please enter an 'other' value for this selection.