Student Registration Form
Course Fee $259
Email address *
Please review the entire form for accuracy before submitting
Class Date *
Last Name: *
Your answer
First Name: *
Your answer
Middle Name: *
Your answer
Address: Street & CITY, STATE, ZIP *
Your answer
Driver's License # & State *
Your answer
Driver's License Expiration Date *
Your answer
Height: *
Your answer
Sex: *
Date of Birth: 00/00/0000 *
Your answer
Phone Number: (000) 000-0000 *
Your answer
Riding Experience: *
Confirm Payment
Please copy and paste this link into a new window before submitting this form. https://www.paypal.com/cgi-bin/webscr?cmd=_s-xclick&hosted_button_id=LRQ5N2NCLLX7J *
Policy and Procedures/Course Schedule
(PLEASE RECORD MEETING TIME AND LOCATIONS OF COURSE BEFORE SUBMITTING)
I have read and agree to the policy and procedures outlined on the course webpage *
Required
You are Not Enrolled Until Form is Complete & Payment is Received
A copy of your responses will be emailed to the address you provided.
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