Mount Kembla 2018 2 Stroke Cup Registration
Saturday 27th October 2018
Sunday 28th October 2018
Mount Kembla Dirtbike Complex
340 Harry Graham Drive Kembla Heights NSW 2526
admin@wollongongmotorcycleclub.com
(02) 4271 8336
Entries close 8pm Sunday 7th October 2018
Email address *
ONE PERSON PER FORM
A separate form must be used for each person entering the event
Family Name *
Your answer
Given Names *
Your answer
Gender *
Date of Birth *
MM
/
DD
/
YYYY
Contact Telephone Number *
Mobile preferred
Your answer
Emergency Contact Name & Telephone Number *
Mobile preferred
Your answer
MA Race Licence Number
Leave empty if you are over 18 years old and requiring a one-event licence
Your answer
MA Licence Expiry Date
Leave empty if you don't have an MA Race Licence
MM
/
DD
/
YYYY
Marshal Name and Phone Number *
Your answer
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