| Last Name: |
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| First Name: |
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| Gender |
Female |
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Male |
| Address Street 1: |
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| Address Street 2: |
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| City: |
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| Zip Code: |
(5 digits) |
| State: |
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| Daytime Phone: |
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| Evening Phone: |
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| Email Address: |
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| Cell Phone: |
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| Date of Birth: |
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| Age: |
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| Motorcycle Permit Number: |
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| State Issued: |
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| Please list any medical conditions that would interfere with your ability to ride a motorcycle?: |
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Do you have any motorcycle riding experience?
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No |
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Yes |
| If you have riding experience, please explain: |
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Are you interested in: (Please check only one)
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Beginner Package: $400.00 Four one-hour lessons, MSF book and Road Test Service |
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1 Lesson and Road Test Service: $235.00 |
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Road Test Service only: $175.00 |
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Lessons Only: (2 Lessons min) $80.00 per hour
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Fast Track Service: $550.00 (Same features as Beginner Package, but lessons are compressed into one day) |
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Additional Lessons (beyond any $70.00 lesson package) per hour |
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COLLEGE STUDENT DISCOUNT (must show college I.D.)
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Beginner Package: SAVE $50
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1 Lesson & Road Test Service: SAVE $25
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Individual Lessons: $60 per hour
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All road tests include pre-test practice time
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Make checks payable to: On The Road Again
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