Booking Form Victoria

Name:	(required)
Email:	(required)
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.


Home \| Company Profile \| 25th Anniversary \| Course Calendar \| NSW \| QLD \| VIC \| ACT \| TAS \| SA \| WA \| NT \| ATV Training \| What's New \| On-Road Tours \| Gallery \| Archives \| Testimonials \| Sponsors \| Road Safety Links \| Riding Tips \| Employment \| Contact Us \| Shop
..Web design by Logopix	Copyright © 2006 Stay Upright Pty Ltd	July 17, 2006