Training Wheels
P.O. Box 784
East Orleans, MA 02643

Motorcycle Course Registration

1. Tell Us About Yourself

Name: __________________________________________________
                                 (first name, last name)
Address: ________________________________________________
City: _______________________ State: _____ Zip: ______________
Cell Phone: (___)______________ Alternate Number: (___)______________
Email: ____________________________

Is it cool that we send you a text that is specific information pertaining to your class
Yes ___ No ___

Male ____   Female____

Date of birth: ____________________________

____ Check here if you are under 18 years of age
(A parental waiver form will be emailed to you.)

I am:
Under 5'3" ___
5'3"-6'4" ____
Over 6'4" ____

Which best describes your motorcycle riding experience (Please don't overthink this answer. The Basic Rider Course is designed for people with little or no knowledge of riding.)
___ I have never ridden a motorcycle before.
___ I have ridden in the past but it was a long time ago or on a smaller motorcycle/dirt-bike and I consider myself a beginner.
___ I have some experience riding and can shift and brake a motorcycle but I still would like to learn to become a better rider.

2. Pick a Location
__Cape Cod  __Bedford  __Brockton  __Framingham  __Kingston-Plympton
__Easton  __Norwood  __Pittsfield  __Wareham

3. Pick a Course
__ Basic    __ Experienced

4. Pick a Class Code

CLASS CODES:    1st choice: _______ 2nd choice: _______

5. Determine Your Tuition

Tuition enclosed: ___________
I have read and accept the Course Descriptions and Course Requirements section of this web site. If payment is by MC, VISA, DISC or AMEX, I accept the Basic Rider Course tuition charge of $355.00 per student; Experienced Rider Course $175; Trike Course $425. Please make check payable to Training Wheels of NE, Inc.

Enter your credit card information here:
___ Mastercard     ___VISA    ___DISC    ___AMEX  (Check One)

Credit card number: ________ - ________ - ________ - ________   Expiration: _______

6. Complete and Sign

Do you have a hearing, reading or other type of disability?  __ Yes   __ No
Do you have a primary language other than English?  __ Yes   __ No

"I have read, understand and accept the Course Descriptions and Course Requirements pages of this website".

You must sign below or your registration is invalid.

7. SIGN THIS SECTION

Student signature: _____________________________________________

8. Mail Us This Form (to the address above) or FAX to (508) 247-9010