Provisional CBT Training Enquiry
Select date from the U-Pass online calendar, please avoid completing on a mobile phone as some data can be blocked by your provider
Title:
Mr
Miss
Mrs
Ms
Dr
Other
Full Name:*
Contact Number:*
Your email address:*
Address:*
Town/City:*
Postcode:*
Prov/Driving Licence No:*
Gender:
Female
Male
Other
Age:*
Height in FT:*
FT
INCHES
License Type Held:
Provisional
Car
Car Driver:
YES
NO
Can you ride a pushbike well:
YES
NO
Course:
CBT ( 1 day communal) £130
CBT ( 2 day communal) £250
CBT Plus - 1 day just you and the instructor £250
CBT2 Plus - 2 day just you and the instructor £480
Prefered Course Date ( Select a date that says space from U-Pass calendar ):
If above date is not available, ANY Dates/Days you CANNOT do:*
CBT Location:
Newton Abbot
CBT Bike:
Please Select
My Own 50cc Auto
My Own 50cc Geared
My Own 125cc Auto
My Own 125cc Geared
Hired 50cc Auto +£25
Hired 125cc Geared +£30
Discount Code:
.................................................
Have you previously undertaken a CBT:
YES
NO
Previous CBT Date:
Previous CBT School Name:
Previous CBT Bike:
AUTO
GEARED
N/A
If you did not complete previous CBT, please explain why ?:
.................................................
Riding History on/off road:*
Health / Aniexty / Learning Issues:*
Comments, licence points / disqualifications*:
.................................................
Name of person completing form if not the named student:
Relation to student if your not the student:
Reason student is not the applicant:
.................................................
I have read the
CBT Page
and confirm the information I have provided above is correct. Providing a false declaration could lead to CBT termination.
#
