Click Here for the Site Index
Site Index

Crash Poll

Just stay calm and try to remember as much as you can...
This is very un-official, non-incriminating and I promise
not to share any information with your insurance agent.
Heh, heh, heh...
really!

Your Email Address (if you want):

The Season when you crashed:

Make of Motorcycle:

Model or Size in cc's:

Model Year:

Your age at crash:

Were you wearing a Helmet?:

On Road or Dirt?:

Under the Influence of any Alcohol or Drugs?:

Were you seriously injured?:

Were you riding two up?:

Were you riding with a group?:

Was your bike loaded with gear?:

In your own words:







This Page Copyright By The Reverend Chuck :^)>+, 1998 -> 2008. Please Make Requests To The Site Owner Rev. Chuck
For Permission To Use Any Images Or Content Contained In This Web Site.
All Other Content Is Copyrighted By Its Respective Owners.