Bronze

Starting on Sunday, 17 November, 2024

Presented by Jason and Kevin

First name *

Last name*

Email*

Mobile phone*

Suburb*

Region (Council)* Please select... Nelson District Tasman District Marlborough District West Coast District Other

Age group* Please select... 15 - 19 20 - 24 25 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70+

Licence Class* Please select... 6L Learner 6R Restricted 6F Full Car (moped/scooter 50cc)

Date of birth *

Gender * Please select... Male Female

Licence Number * E.g : AB123456

Licence (Class 6) issue date *

Time riding (years) *

Bike I will use on the course *
Please select... Adventure Classic Commuter Cruiser Dual Purpose Naked Scooter Sport Tourer Bike you are providing for me ( 225cc - $100.00 fee applies )

CC rating of your motorcycle * Please select... 50 100 125 200 225 250 350 450 550 650 750 850 1000 1200 1300 1400 1500 1600 1700 1800 2000+

Make and Model (Optional)

Previous motorcycle crash on road * No Yes

Please Provide a brief description*

Main use of your motorcycle * E.g : (commuting, pleasure, weekend rides, touring etc)

Areas to be improved *

Rate your current riding ability * Please select... 1 - total beginner 2 3 4 5 6 7 8 9 10 - Valentino Rossi (Pro)

How did you hear about this course?*e.g. (Kevin, Jason, Mitch, radio, google search, friends, AA etc)

Have you previously attended a Ride Forever Course? * No Yes