REGISTRATION FORM

CLOSING DATE FOR REGISTRATION 12th SEPTEMBER 2010 

REGISTRATION ON THE DAY ( SUBJECT TO SPACE )WILL INCUR A  SURCHARGE OF £10 DONATION

The UCAN Trophy Fun Run, SUNDAY SEPTEMBER 19th 2010, will start from Pannanich Wells Hotel, South 

Deeside Road, Ballater (on the B976) at 12noon for signing in and first bike will leave around 12:30hrs

 

Name

 

                                                           Age last birthday_____

                                                         ( For cup calculation only)

Address

 

 

 

 

 

 

 

 

Telephone

(mobile if possible)

 

E-mail

 

MOTORCYCLE

 

Make

Model

CC

MOTORCYCLE Reg. Number.

 

 

First reg. Date  from log book

(For cup calculation only.)

Riders Driving Licence Number.

Insurance policy No

And company name

 

                                                        

 

 

I enclose a cheque for £20 registration fee                Please deduct £20 from my credit card

 My card details are as follows:

   Card Number                                          Start date             Expiry date         3 figure security                                 

 

                                              Signed….

 

 PLEASE RETURN THIS COMPLETED FORM WITH YOUR REGISTRATION FEE TO:-

                                    U.C.A.N. TROPHY FUN RUN

                                           c/o   PANNANICH WELLS HOTEL,

                SOUTH DEESIDE ROAD, BALLATER, ABERDEENSHIRE,  AB35-5SJ

                                       OR:-  chrisnorton.chris@gmail.com

 

If you intend to send this by email please break credit card number onto at least three emails for security.