Helmet Registration Form

*First name

Middle name

*Last name

Address

City

Province
—Please choose an option—ABBCMBNBNLNSNUNTONQCPESKYT

Postal Code

Your Age

Gender
—Please choose an option—MaleFemaleRather Not Say

Your email

*Product Purchased
—Please choose an option—EQ3 Smooth ShellEQ3 Micro SuedeLynx

*Size
—Please choose an option—SML6 1.56 3.46 5.86 7.877 1.47 1.57 1.87 3.8

Colour
—Please choose an option—BrownBlueBlack

*Purchase Date (MM/DD/YYYY)

*Price ($ Excluding TAX)

*Name / Location of Retailer

How many days per month do you ride?

Do you primarily ride Western or English?
—Please choose an option—WesternEnglish

*Batch Number