BMW RA Rally Information and Signup

LearnToRide.ORG will be conducting three RiderCourses using the MSF approved ERC RiderCourse Suite at the BMW RA Rally in Shelbyville, Tennessee on October 6, October 7 and October 8, 2005.

Each class will run from 9:00 AM until approximately 3:00 PM. There will be a midday lunch break during the class.

These classes are only applicable to experienced motorcycle riders. If you have little or no experience riding a motorcycle and would like to take a basic course you are invited to sign up for one of our Basic RiderCourses instead.

NO REFUNDS WILL BE MADE, EXCEPT FOR CANCELLED CLASSES. The special price for these classes is $45.00.

Please note: Fields marked with an asterisk (*) are required. Your application will not be able to be processed until all these fields are completed!

Name and Address

First Name	*
Middle Name
Last Name	*
Address 1	*
Address 2
City	*
State	*
Zip	*

Contact Information

Telephone	*
Alt Telephone
Fax
Email (Optional)

Note: We will not give or sell your contact information to anyone else. If you provide an email address we will only use it to contact you for pertainent class purposes.

Gender *

Male
Female

Birthdate (MM/DD/YYYY)

Age

Tee Shirt Size

* (XS, S, M, L, XL, XXL, XXXL)

Required Information

Race: *
Tennessee Resident?
US Citizen * Yes No

	If "No" Enter the following information:
Type of Visa:
Card Number:
	Please attach a copy of your card with the waver when mailing.

(Please note that this information is required by the state as a requisite for conducting this course through the Nashville State Technical Community College.)

Social Security #

Driver's License # and State

* Note: Enter "N/A" if you do not have a Driver's License

Preferred Date

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