MT Push and E-Trike Trial Registration

Name*

First Last

Email*

Mobile Phone Number*

Are you registering for yourself or on someone’s behalf?*

If on someone’s behalf, please provide his/her name and your relation to him/her

Name*

First Last

Relationship*

As part of the event and for publicity purposes, photos can be taken at the event. Do you agree to give us a consent to be included in these photos?*

Which trial site would you like to do the trial?*

Minlaton Caravan Park

Which date/time would you like to do the trial?

Please select only one

30 September

1 October

2 October

3 October

4 October

Which time would you like to do the trial?

Please select only one

5 October

Which date/time would you like to do the trial?

Please select only one

6 October

7 October