<% Response.Buffer = True %> Registration BRC
Registration Form - Refresher Basic Rider Course  (* = required fields)


  1. TELL US ABOUT YOURSELF

  Middle Initial:    Last Name*:

Address Line 1*: 

Address Line 2: 

Address Line 3: 

City*:    State*:    Zip Code*:

Day Phone*:    Evening Phone:

eMail Address*:   

Motorcycle License or Permit Number:  (it is the same as your license #)

Age*:

Birth Date - Month*:   Birth Date - Day*:    Birth Date - Year*:

  1. Pick 2 Class Options

Choose a class.  Please provide a 1st and 2nd choice.  You can see a list of available classes on the SCHEDULE link.

1st Choice*:     2nd Choice*:

Notes (where did you hear about Streetwise Cycle School?):

  1. Enter Your Course Tuition.

IMPORTANT! Tuition = $125 for the Refresher Basic Rider Course.  Please make credit card payment with PayPal (note: you do NOT need to have a PayPal account).  To pay, click on the "Buy Now" button in Step 3 of the registration process (on the previous page).

Amount Paid*:       PayPal Confirmation Number:

If you are redeeming a Gift Certificate for full or partial payment, enter the Certificate Number below:

Gift Certificate Number:

  1. Signature

  Check here if you have a leg in-seam less than 26 inches.

  Check here if you have a hearing, reading, or other type of DISABILITY.

  Check here if you have a primary language other than English.

If you checked any of the above items, please call the office at (781) 974-2474 prior to registering to discuss if we can accommodate your special needs.

Read the Terms, Course Descriptions, and Course Requirements and click on the "Yes, I ACCEPT" box below.

I ACCEPT the Terms, Course Descriptions, and Course Requirements outlined above?*

You must accept the Terms, Course Descriptions, and Course Requirements in order to register.