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Honda SMART Entry Form Dubbo


									HONDA SMART - The SMART School has been developed and designed to enhance your riding and racing ability and offers you the opportunity to
learn from some of Australia’s best. You will have the chance to enjoy a vast learning experience that includes- braking, cornering, jumping, stutters,
and bike set up. The Honda SMART program will enhance and develop your skills whether you are a beginner or an expert.
ALSO! In addition to the school’s lessons, students will receive a gift bag, certified kit containing certificate, Honda SMART loyalty voucher, a copy of
StrokeMX magazine, a free hat or beanie, stickers, motorcycling information and more!
JNR. COACHING REQUIREMENTS, 125/250 endorsement & Kick Start - The Honda SMART training schools can go towards the compulsory 5 hour
Junior Coaching Program. Also endorsements for 125cc and 250cc can be obtained at Honda SMART schools. The Junior Coaching Program applies to
juniors aged between 7-16 who wish to obtain or renew a competition license.
HONDA SMART INSTRUCTORS 2009 - Yarrive Konsky, Paul Broomfield, Glen Bell, Peter Boyle, Jye Harvey, Brent Landman, Tom Jones, Adam Bailey,
Ben Williams, Todd Waters, Dean Ferris, Ford Dale, Adam Robinson, Lee Ellis, Cameron Sinclair (FMX), Blake Williams (FMX) and Craig Anderson (Elite
SCHOOL TIMES - Sign in from 8.30am. Coaching begins from 9am to approximately 4pm. Please note that children under the age of 18 must not be
left at the school without a parent or guardian. Please contact our office with queries or to obtain a temporary guardianship form.
TO REGISTER - Please fax, email or send your completed entry form & payment to Full Throttle Sports, at least 1 week prior to the school.
Acceptances and further information will be emailed or posted out once minimum numbers have been received.

                                            2 DAY MOTOCROSS SCHOOL
                                                       Dubbo Dirt Bike Club
                                                      November 7 & 8 $189
Rider Details:                                                                                       Please print clearly

Name: ______________________________________________________________________________ D.O.B: _________________ Age: _______

Postal Address: ______________________________________________________________________ State: ___________ Post Code: __________

Phone: _________________________ Mobile: ____________________________ E-mail: ______________________________________________

Parent / Guardian (if rider is UNDER 18 years of age): _________________________________________ Mobile: ___________________________

Emergency Contact (if rider is OVER 18 years of age): _________________________________________ Mobile: ___________________________

Motorcycle Make, Model, Capacity: _______________________________ Rider Grade/Ability: ____________________ Race number : ________

MA License Number: ________________________ License Expiry: _____________________ Club: ______________________________________

        * MA Licenses required for all riders for personal insurance reasons. Please note that day licenses are $20 extra, if required please add to overall price. *

MA Day License Required:        □                      I require 125/250 endorsement         □                  I require Kick Start Assessment       □
Payment Details:

I would like to pay by:     □    Cheque (payable to Full Throttle Sports)   □      Money Order (payable to Full Throttle Sports)

Please Debit My Credit Card:        □      Mastercard        □     VISA                  For The Total Amount of:       $_____________

Card Number:   □□□□ □□□□ □□□□ □□□□                                                                                                 Expiry:   □□/□□
Name On Card: ____________________________________________________ Signed: _______________________________________________

                          P.O. Box 9087,                                    Ph 03 97852786                        
                          Seaford, 3198.                                    Fax 03 97865804                        

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