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TELL US ABOUT YOURSELF
First Name*: Middle Initial: Last Name*:
Address Line 1*:
Address Line 3:
Day Phone*: Evening Phone:
eMail Address*:
Motorcycle Permit Number: NOTE: If you would like to get your motorcycle license as a result of passing the entire Basic Rider Course (classroom and riding), you must have your permit prior to taking the FREE classroom training
Age*: 16-17 18-20 Over 21
Birth Date - Month*: 1 2 3 4 5 6 7 8 9 10 11 12 Birth Date - Day*: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Birth Date - Year*:
Choose a class. Please provide a 1st and 2nd choice. You can see a list of available classes on the SCHEDULE link.
1st Choice*: Select 1st Choice Class Check back in Dec for 2009 Schedule 2nd Choice*: Select 2nd Choice Class Check back in Dec for 2009 Schedule
Notes (where did you hear about Streetwise Cycle School?):
IMPORTANT! This classroom training is FREE. If you decide to take the Riding portion of the Basic Rider Course, the tuition = $265 for Basic Rider Course.
Amount Paid*: PayPal Confirmation Number:
If you are redeeming a Gift Certificate for full or partial payment, enter the Certificate Number below:
Gift Certificate Number:
Check here if you have a leg in-seam less than 26 inches.
Check here if you have a hearing, reading, or other type of DISABILITY.
Check here if you have a primary language other than English.
If you checked any of the above items, please call the office at (781) 974-2474 prior to registering to discuss if we can accommodate your special needs.
Read the Terms, Course Descriptions, and Course Requirements and click on the "Yes, I ACCEPT" box below.
No Yes I ACCEPT the Terms, Course Descriptions, and Course Requirements outlined above?*
You must accept the Terms, Course Descriptions, and Course Requirements in order to register.