MIAS Registration - Ride Camps
First Name *
Surname *
Date of Birth *
MM
/
DD
/
YYYY
address *
Occupation *
email *
Phone Number *
Course Provider *
Course Start Date *
MM
/
DD
/
YYYY
Course Level *
Emergency Contact *
Nationality *
First Aid Qualification Provider and Expiry Date *
Medical conditions or injuries that we need to be aware of *
Are you sufficiently insured for your trip including if you were to have an accident practicing mountain biking? You can provide us with details in case we need to assist you with an emergency. *
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