Tour de Isan Rider Registration - Step 1 of 3

Registration is US$295 and is payable by PayPal or credit card. You will be directed to the PayPal site to make your payment on completion of the Rider Registration forms. You do not need a PayPal account to pay by credit card; PayPal accepts all major credit cards.

All riders are required to raise a minimum of US$1,000 in donations. Donations are due by June 15th, 2009.

Thanks to the generosity of our sponsors, 100% of all donations will go directly to the charities.

Please fill out the form below.

First Name * Required
Last Name * Required
Age
Sex Male
Female
Jersey Size
Mailing Address 1
Mailing Address 2
City
State / Province
Postal Code
Country
Day Phone
Evening Phone
Email * Required
Emergency Contact
Contact Phone
Participation Entire Ride (June 27th to July 7th) $295
Bike Rental No Bike Rental Necessary
Full Ride (US$100)
Single Supplement I am OK with Sharing a Room (No Charge)
Full Ride (US$150)
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