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Payment Details.

Direct Debit (Please quote riders surname in description)
Comm Bank (CBA)
Account Name: S Metcalfe
BSB: 065000
Account No. 11928630

MA Guardianship Form

All fields are required

Please YAIM Select Course: 

Please Select Venue: 

Enter Your Name: 

Enter Your Age:

Enter Your Date of Birth:

Enter Your Address:

Enter Your Mobile Phone:

Enter Email Address:

Parent / Guardian name and Phone number - (If rider under the age of 18 Yrs):

Emergency Contact name and Phone number - (If rider is over 18 Yrs):

Bike Manufacturer & Size:

What club are you a member of:

Motorcycling Australia Licence No:

Licence Expiry Date:

Motorcycling Australia Day Recreation Licence Required $30.00 (Please Select): 

Payment Type (tick the box section?) (Please Select): 

Please enter any comments here:


VIC Cameron Taylor

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