REGISTRATION FORM

Registration – Start Training In 2 Easy Steps!

To register for training, simply complete these simple steps: STEP 1: Complete this online form (all information is required). STEP 2: Deposit by Mail or Credit Card of $100. (required) Mastercard, Visa & Discover Card accepted.

Call (631) 862-RIDE to charge your deposit or mail check or money order to: On The Road Again, P.O. Box 540, Stony Brook, NY 11790. Upon receipt of this form, an OTRA representative will contact you to schedule your training session. Your motorcycling adventure starts here!

P.O. Box 540, Stony Brook, NY 11790 • Phone (631) 862-RIDE, or (631) 756-RIDE • FAX (631) 689-1792

Last Name:
First Name:
Gender	Female
	Male
Address Street 1:
Address Street 2:
City:
Zip Code:	(5 digits)
State:
Daytime Phone:
Evening Phone:
Email Address:
Cell Phone:
Date of Birth:
Age:
Motorcycle Permit Number:
State Issued:
Please list any medical conditions that would interfere with your ability to ride a motorcycle?:
Do you have any motorcycle riding experience?	No
	Yes
If you have riding experience, please explain:
Are you interested in: (Please check only one)	Beginner Package: $400.00 Four one-hour lessons, MSF book and Road Test Service
	1 Lesson and Road Test Service: $235.00
	Road Test Service only: $175.00
	Lessons Only: (2 Lessons min) $80.00 per hour

	Fast Track Service: $550.00 (Same features as Beginner Package, but lessons are compressed into one day)
	Additional Lessons (beyond any $70.00 lesson package) per hour
	COLLEGE STUDENT DISCOUNT (must show college I.D.)
	Beginner Package: SAVE $50
	1 Lesson & Road Test Service: SAVE $25
	Individual Lessons: $60 per hour
All road tests include pre-test practice time	*Make checks payable to:* On The Road Again