BORANG ONLINE PENDAFTARAN PEKEMA RIDERS CLUB

PEKEMA RIDERS CLUB MEMBERSHIP REGISTRATION FORM

APPLICANT INFORMATION

Your Name (required)

Date of Birth (required)

Contact Number (required)

Your Email (required)

T-Shirt Size(required)

Your Address

MOTORCYCLE OWNERSHIP & RIDING INFORMATION

Make

Year

Model

Chassis Number

Vehicle Registration Number

Dealer's Name

How Long Have You Been Riding Motorcycle ? (Please Pick One)

Are You a Member Of Any Motorcycle Group Or Club? (Please Pick One)

If yes,Please Provide Your Motorcycle Group or Club

EMERGENCY CONTACT

Name

Relationship

Contact Number

Email

Address