Breakout Rally Form — Remote ADV

Name

First Name

Last Name

Email

Phone

(###)

###

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What is your bike registration?

So we can arrange permits for the forest on your behalf

T Shirt Size

Just so we can gauge potential numbers, are you interested in:

Note that you still need to arrange your accommodation with NZCIS directly https://www.nzcis.co.nz/contact or call 04 213 9231.

NZCIS Accommodation

Breakfast at Fig Tree

Emergency Contact Name

First Name

Last Name

Emergency Contact number

(###)

###

####

Any dietary requirements or questions?

Register for the Breakout Rally

This event is now sold out: Please still fill in the form if you would like to go on the waiting list and we will send you an email with payment details as soon as any spots open up.