Event/Coaching Bookings Form

If you would be interested in making a booking simply fill in the details below along with a short message and we will get back to you to confirm your booking.

Bookings Form

Fields marked with an * are required.

Have you been coached by us in the last 12 months?

Have you been coached by us in the last 12 months?*

Your Details

Riders Full Name*

Date of Birth*

Parents Name (if under 18)

Email Address*

Phone Number*

(e.g. 09 1234567)

Region*

Event you're interested in?*

(e.g. Auckland, 15th July)

Your Experience

What year did you first start riding? (eg. 2010)

What year did you first start racing? (if applicable)

What is the main type of riding that you do?

(hold down CTRL key to select multiple options)

How would you rate your ability?

What type of bike do you ride?

Coaching preferences

1 on 1

1 on 2

1 on 3

Group

Select as many as you want.

Any Comments

Please tell us if you have any special requirements or if there is anything else you'd like us to know (e.g 1 on 1 preference, start time preference etc).

Yes! Subscribe me to the Broxy Newsletter

Terms and Conditions / Waiver

Indemnity: I irrevocably indemnify Broxy Rider Coaching, Blue Wing Honda, Peter Broxholme, land owners, officials and employees against any and all actions, claims, suits, proceedings, demands, liabilities, damages, payments, losses, costs, injuries and expenses arising from our attendance at this event. They are absolved from any liability arising out of any accidents however caused, resulting in damage and/or personal injury.

I have read and agree to the Terms and Conditions *

We will use these contact details for following up on your request. We will not share your information with any third party outside of our organisation. Learn more about how we handle your information in our Privacy Policy.

Comments

This field is for validation purposes and should be left unchanged.

Event/Coaching Bookings Form

Bookings Form

Have you been coached by us in the last 12 months?

Your Details

Your Experience

Any Comments

Terms and Conditions / Waiver

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