Gwent Police BikeSafe Weekend Workshops 2009 Application Form

Name:

Address:

Post Code:

Telephone Number:

Age Group:


17-19

20-29

30-39

40+

Any post test training?

Year you passed the motorcycle test:

Have you recently returned to motorcycling after a
period of absence? YES/NO

Approximate Annual Mileage Per Year?

How did you hear about Bikesafe workshops?

Motorcycle Details:

Make:

Model:

Please circle your choice of weekends:


May 9/10
May 30/31 Malpas Fire Station
June 6/7
June 20/21 (Armed forces only)
July 4/5 (Ladies only) Edlogan Way,  Cwmbran
July 18/19 Malpas Fire Station
Sept 5/6 Edlogan Way,  Cwmbran
Sept 19/20 Malpas Fire Station

 

 

 

 

The cost will be £100.00 per rider. Please enclose a cheque made payable to Road Safety Wales. The cheque will not be cashed until you have been allocated a place on one of the workshops - it will then become non-refundable. Please note that if you intend to bring a pillion passenger there will be an additional charge of £10.00 per day.

I intend to bring a pillion on None/One/Both days (delete as applicable)

Cheque enclosed £

Please specify any dietary needs.

 

  Please read the following declaration and sign below
I understand that the workshops will include on road riding, and that it is my responsibility to ensure that all relevant legal requirements will be complied with and that the Gwent Police will not accept any liability for loss, injury, theft or damage whilst on police property. This is not a training course.
Signed..........................................Date...............................

 

Please return the completed form to:
J Bibby, Road Safety Wales, 2 Cwrt y Parc, Parc Ty Glas,  Llanishen, Cardiff CF14 5GH