Register - Moris Track Day Insurance

Affiliate Application

Club / Company Name:

Website:

Club Initials:

Year Established:

Contact Name:

Position:

Address line 1:

Address line 2:

Town:

County:

Postcode:

Telephone/Mobile:

Email: Note: Check email address.

Password:

Type of Affiliate:

Activity Profile

This helps us to identify where we can best help you and your members

Approx number of Club members:

Approximate number of events you will be organising in the next 12 months?

Rally:

Race:

Speed:

Kart:

Trials:

Auto Test:

Other:

Activity Profile

This helps us to identify where we can best help you and your members

Approx number of Club members:

Approximate number of events you will be organising in the next 12 months?

Motorcross:

Trials:

Road Race:

Enduro:

Track Racing:

Speedway:

Supermoto:

Sprint:

Other:

Activity Profile

This helps us to identify where we can best help you and your members

Approximate number of events you will be organising in the next 12 months?

Cars:

Bikes:

Declaration

Affiliate agreement terms and conditions

I/we confirm we have read and understood the terms set out between ourselves and Indigo Underwriters Ltd T/A MORIS

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