Basic Rider Course #647-Weekend-Ladies Only

Please Enter the Following Student Information

First Name

Last Name

Email Address

Street Address Line 1

Street Address Line 2

City

State

-- Please Select --Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachussetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Other

Zip Code

Phone Number

XXX-XXX-XXXX

Valid Drivers License Number

A000-0000-0000-00

Birthdate

MM/DD/YYYY

Gender

• Male
• Female

Height

Weight

Have you previously ridden a motorcycle?

• Yes
• No

T-Shirt Size (For Commemorative Road America Motorcycle T-Shirt)

-- Please Select --2 Extra Large 3 Extra Large Extra Large Large Medium Small

Do you need to rent a helmet?

• Yes +$10.00

Please select a helmet size

-- Please Select --Small Medium Large Extra Large 2 Extra Large

I understand there is a required 3 hour online eCourse that I must complete before my class

• Yes

MSF Waiver

By checking this box you are confirming you have read and agree to sign our waiver

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