| Document Date: 2014-10-28 11:28:59
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City Motorsport / / Company The Auto-Cycle Union Limited / BP / ACU Ltd / ACU Events Ltd. / Sprint / DVLA LGV/PCV Group / / Currency GBP / / IndustryTerm on-line membership system / / MedicalCondition loss of consciousness / brain disorder / hypertension / cancer / progressive neurological disorder / disease / neoplasm / psychiatric illness / stroke / vertigo / tumour / emotional illness / Diabetes / personal injury / very serious injury / psychiatric disorder / insulin dependent diabetes / blackouts / serious injury / injury / Deafness / colour blindness / heart attack / serious injury I / cardiac disease / serious cardio-vascular disease / Epilepsy / cardiac rhythm disorders / high blood pressure / dizziness / Motor Neurone disease / MS / serious injuries / Neurological and psychiatric disorders / head injury / / MedicalTreatment Amputation / / Organization Auto-Cycle Union / Court of Arbitration for Sport / Registered Office / / Person Diabetologist / Tick / / / Position General Practitioner / Cardiologist / incident officer / Clerk / paramedic / Consultant / Rider / / SportsEvent World Championship / / Technology cellular telephone / / URL acu.org.uk / www.wada-ama.org / www.acu.org.uk/general/medicalmatters.aspx / /
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ACU Comp Licence-Enduro 2015:x:52 Page 1 You should read and understand the enclosed notes before filling in this form If this is your first