Dirtbike.com.au "Oberon 6 Hour" Trail Ride 16th November Entry Form

First Name *

Last Name *

Address, Town , Postcode *

Email address *Please ensure this email will be functional

Mobile phone number *

Emergency Contact, Name and Number *

Ambulance Cover *Mandatory for MA Trail pass

Any Medical conditions or information we should know about Allergies, Asthmatic, diabetic ETC ??

Terms and conditions:

Please read the terms and conditions of entry at

https://drive.google.com/file/d/1HWzTHiCjsycpXBrDz_jr2AIKb67_s6yJ/view?usp=drive_link

You must agree to the Terms and Conditions of entry for your entry to be valid.

Yes, I have read and agree to the Terms & Conditions of the Indemnity form. *

Yes, I will Watch and agree to the Terms & Conditions of the Riders Briefing Video Link .
Video will be posted here http:// and on social media 2 weeks before event . *

Yes, I agree to the Terms & Conditions of entry. *

Licence's and Registration information

Please complete the following information. Upload copies of licences and registration ,

Please upload drivers licence image file (.jpg / .png) *

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Please upload Motorcycle Registration image file (.jpg / .png) *

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MA License or One Event License, upload image *

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Make, Model, Year

Registration Number *

last 4 digits of the VIN *

Please check your work before you press Submit.

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