• Personal Info 1
• Personal Info 2
• Passport Info
• Emergency Contact
• Medical Info
• Medical Declaration
• Other Info

(*) required field

Personal Info 1

First Name:*

Middle Name:

Last Name:

Alias:

Password:

Confirm Password:

Email:*

Contact Number:*

Gender:*

Male

Female

Date of Birth:*

Occupation:*

Company:*

NRIC (Singaporean/Singapore PR Only):

NRIC Type: Please Select Pink Blue

Personal Info 2

Address 1:*

Address 2:

City:

Postal Code:

State / Province:

Country:* Please Select (Type your country)

Passport Info

Passport Number:*

Passport Expiry:*

Nationality:* Please Select (Type your country)

Screenshot of Passport Details Page:

If you do not have access to your document you can submit the file later. Bintan & Batam travellers please note: no passport screenshot, no travel

Update Passport Upload Passport

Emergency Contact

Name:*

Contact Number:*

Relationship:* Please Select Family Friend

Medical Info

Blood Type:

Medical Details/Allergies:

Medical Declaration

Other Info

Dietary Requirements:

Riding Experience: Please Select Beginner: less than 1 yr experience riding & not confident with bike handling Intermediate: min. 1 yr of regular group riding & confident to descend & corner Advanced: min. 3 yrs of regular group riding/racing

Name of Cycling/Triathlon Team:

T-shirt size:

Sizing

Please SelectXSSMLXL

Insurance Company & Hotline Number:*

How did you get to know about Jacqtours?: Please Select Google Adwords/Internet Search Facebook/Instagram Event website World of Mouth/Recommendation

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