REGISTRATION FORM

Rider's Info

First Name:

  

Last Name:

  

Nationality:

Date of Birth:

Day:

Month:

Year:

Email:

Emergency Phone:

Blood Type:

Bike Model:

HOG Membership #:

HOG Membership Expiry:

Day:

Month:

Year:

Passport #:

Passport Expiry Date:

Day:

Month:

Year:

T-Shirt Size:

Passenger Info

First Name:

Last Name:

Nationality:

Date of Birth:

Day:

Month:

Year:

Blood Type:

Passport #:

Passport Expiration Date:

Day:

Month:

Year:

T-Shirt Size:

Choose Package:

 Package A “Single” $ 1100 Package B “Double” $ 1800

For security reasons please write the result in the box below

15 + 12 =

Bank account detailes will appear after submitting your registration

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