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*1.	Please enter your details so we can mail the free pack to you

First Name
Surname
Address 1
Address 2
City/Town
County
Postal code
Contact phone number

*2.	Email address

About you:

3.

Sex

Male Female

4.	What age group do you belong to?

About your helmet purchase:

6.	Please tell us the date you purchased your helmet (DD/MM/YYYY) NB: promotion applicable to helmets purchased from 1st July 2009 onwards.

7.	Please tell us the name of the Arai Five Star dealer or Hein Gericke Store from which you purchased your new Arai helmet

8.	Please supply the unique helmet serial number (found on the orange tag located on the chin strap- NOT the P number - SEE ABOVE)

9.	Newsletter

The Arai monthly newsletter will help keep you up to date with all the latest Arai news, promotions, launches and events happening throughout the year. We'd suggest having a look at it - if you don't like it you can simply unsubscribe. However - if you really don't want to give it a 'road test' you can opt-out by ticking the box.