Asian Motorcycle Adventures

Pillion Application Form

Pillion Application Form

Title Family Name First Name Middle name / initial
Email *
Country of Residence Mailing address exactly as it should be written on an envelope
State/Province of Residence
City of Residence
Age * Birth Date: Day Month Year
We need your height and weight to assign you a specific motorcycle and set it up correctly.
Height * Weight *
Shirt Size (CHOOSE A SIZE!) * Blood Type
Passport Number * Passport Expiry Date Passport Country
Occupation
Contact Phone #: Country Code City / Area Code Telephone #
Emergency Contact Person Relationship
Country of Residence of Contact Person Emergency Contact Person telephone #
Country Code City / Area Code Tel. #
Selected Motorcycle Tour Tour Price (USD)

Tour Start Date Tour End Date
Would you like A.M.A to make any pre/post tour hotel reservations for you at our usual tour lodging?
Anything else you want to tell us or inform us about about your upcoming tour?
 
Read the Terms & Conditions - Indemnity, and Release Form. (Required) *
I have read the Terms & Conditions - Indemnity, and Release Form.
 

 

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