CyclingSouth Adult Cycling Course-Apr 2012

First Name

Surname

Street Address

Suburb

Postcode

Phone number

Date of birth

Learn to Ride (March 2012)

Intermediate Cycling Skills Course (to be announced-May 2011 course is full)

Please specify the date

No, I have my own bike and helmet

Yes, I require a helmet

Yes, I require a bike

If you require a bike please specify your height