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Riders Name ___________________________________________________
Number _________________________
Club ___________________________________________
Time _____________________________
Physically OK = YES NO Need DR = YES NO
Last Check Passed ____________ Mile
Point/GPS _______________________________________________________
Bike Description ___________________________________________________
Problem______________________________________________________________________
_____________________________________________________________________________
Action Rider Taking________________________________________________________________________
_____________________________________________________________________________
Stub received by__________________________________________________Number___________________
PLEASE !!! RADIO THIS INFORMATION TO HOME CHECK!!!
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