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  Booking Enquiry Form  
     
 
 
Name:
(required)
Email:
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Address:
Suburb:
City/Town:
Postcode:
Phone (H):
Phone (W):
Mobile:
 
COURSE INFORMATION
Course Location:
Course Type:
   
When would you prefer to participate in the course?
Weekday Weekend Either
   
Please enter your preferred date to take part in the course.
   
LICENCE INFORMATION
Do you hold a current Victorian car licence?
Yes No
If "No", has your licence been:
Suspended Cancelled Not Applicable
   
RIDING EXPERIENCE
Have you had any riding experience?
Yes No
If "Yes", please enter amount of experience.
Years: Months:
Type of previous riding skills?
Road Off-Road Both None
   
Do you suffer a Medical Condition or take any medication that may afftect your driving?
Yes No
(i.e. eyesight/hearing defect, epilepsy, diabetes, dizziness, blackouts, other illnesses.)
   
Your Comments:
 

We will contact you shortly for confirmation of your requested booking.
If there is no course available on your preferred date, we will inform you of the nearest alternative.
 
 
     
 
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April 27, 2010
 
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