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REGISTRATION
REGISTRATION CLOSES 2019/07/28
HOG DETAILS
HOG International Number
HOG Chapter Name
RIDER DETAILS
Name
Surname
Email
Mobile
Your Ride
Please select a bike
Dyna Super Glide
Dyna Low Rider
Dyna Super Glide
Dyna Wide Glide
Dyna Fat Bob
Electra Glide Standard
Electra Glide Custom
Electra Glide Classic
Electra Glide Ultra Classic
Heritage Softail Classic
Heritage Softail Custom
Heritage Softail Special
Heritage Softail Springer
Road King
Road King Classic
Road King Custom
Street Glide
Wide Glide
Lo Glide
Softail Fat Boy
Softail Deluxe
Softail Night Train
Softail Standard
Softail Custom
Softail Deuce
Softail Springer
Street Rod
V-Rod
Night Rod
Night Rod Special
XL 883R Sportster
XL 883L Sportster
XL 1200C Sportster Custom
XL 1200L Sportster Low
XL 1200S Sportster
XR 1200X
XR 1200
OTHER
Bike Registration Number
Emergency Contact Name
Emergency Contact Number
Emergency Contact Relationship
T-Shirt Size
Please select a size
S
M
L
XL
2XL
3XL
4XL
5XL
Total rally fee per person includes: Entrance to rally site, Pin, Rally Pack, Accommodation x 3 nights, Breakfast and Dinners.
Accommodation
Single (R3700 pp)
Sharing (R3100 pp)
Camping (R2450 pp)
Breakfast
Standard
Other
Dinner
Standard
Other
Questions / Comments
Include a Pillion Rider
2ND ATTENDEE DETAILS
Pillion Name
Pillion Surname
Pillion Email
Pillion Mobile
Pillion T-Shirt Size
Please select a size
S
M
L
XL
2XL
3XL
4XL
5XL
Pillion Breakfast
Standard
Other
Pillion Dinner
Standard
Other
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Terms and Conditions
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