Please Fill In Your Class Dates:
* Introduction to Bicycle Maintenance ($153.12, deposit $90):______________________________
* Professional Repair and Shop Operation ($331.10, deposit $175):__________________________
* Advanced Certification Week ($153.12, deposit $90):____________________________________
* Frame Building ($331.10, deposit $175):______________________________________________
* Alumni Frame Class ($153.12, deposit $90):______________________________________________
* Extra days ($23.80 per extra day):___________________________________________________

Name:________________________________________________________ Sex:      M       F
Home Phone:_____________________________ Work Phone:____________________________
Address:______________________________________________________ Apt #:___________
City:___________________________ State:______ Zipcode:__________ Country ____________

Payment Method:
      Check       Money Order       VISA       MasterCard     Total Enclosed: $_________

Credit Card Information (if paying by credit card):
Card Number:___________________________________________ Expiration Date:____________
Name on Card (required):___________________________________________________________
Credit Card Signature (required):_____________________________________________________

Please Read and Sign Below:
I would like to apply for lodging at the Cycle Hostel. I am enclosing the appropriate deposit amounts, in U.S. dollars, for each of the class periods I will be attending with the understanding that should I decide to cancel, this deposit is forfeited if I do not cancel my reservation, in writing, at least 30 days prior to the start of class. If paying the deposit by credit card, I authorize the Cycle Hostel to charge my credit card at the time my application is processed. I further understand that the balance is due at the time of my arrival and that, without prior notice, if I am not present within one hour of the start of class, I will be considered a no-show and my place in the Cycle Hostel may be taken by an alternate student from the waiting list. I also understand there are no partial lodging refunds for any days missed. The Cycle Hostel's lodging rates are based on a package price. The Cycle Hostel is not responsible for any personal loss or injury during my stay. I understand that drugs and alcohol are not permitted within the Cycle Hostel. Failure to comply with house rules will result in immediate expulsion.

Signature (required for all students):_________________________________Date:___________

Signature of parent/guardian of minor:_______________________________Date:___________

Please Note: Upon receipt of your application and deposit we will send you an acceptance letter. Please pay in U.S. funds only and make your check or money order payable to the Cycle Hostel, not United Bicycle Institute, as they are separate businesses. Faxed applications must have deposits paid for by credit card. Print this form and mail or fax your completed application with deposit to:

The Cycle Hostel P.O. Box 128 Ashland, OR 97520-0128	Reservation Phone: (541) 488-1121 Reservation Fax: (541) 488-3485 Contact Us By E-Mail:
Please call ahead to UBI to check for space availability, (541) 488-1121.