Moto Loco Rider Information Form

Please fill out the form completely to assist in Planning & Customizing Your Tour. We will send a confirmation and a Moto Loco T-Shirt once this is & your deposit are received. This is an important part of our planning procedure and your assistance is greatly appreciated. Be sure to give a brief description of what you are most interested in seeing and doing while here in Ecuador. You just want to travel from one tourist attraction to another then say so. If you want to Moto in Beautiful Scenery on Backroads & Trails then say so. Want to Moto on knarly trails and do a Cross Country Race while here and care less about city tours then tell us! Initials, birth year and last four digits of your SS#, or any four digits, make up your Moto Loco ID# that can be used to purchase parts in our members store.

First Name M.I. Last Name
Initials Last 2# Year Born Last 4# SS#
Your E-mail Your Tele# Other Phone#
Send Mail To Street Address Address 2nd line
City State Zip
Country Country Phone Code Your Fax#
Emergency Contact Emergency Tel# Emergency E-mail
Alternate Contact Alternates Tel# Alternates E-mail
Type of Tour Tour Dates Group Size
Deposit Sent yes/no Deposit Amt. $xxx Date Deposit Sent

Set-Up Information & Motorcycle Riding Summary
Weight(with riding gear) Height Suspension Set-Up Firm/Med/Soft
Offroad vs Street Motorcycling Experience Riding Ability

WHAT DO YOU WANT TO DO?

Please Fax the completed form to 603-584-1257

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