Complete this form to register for your Course

Course:			Date:
Name:			Email:
Address:			Phone:
City:			Evening:
State:	Zip:		Cell:
Age:	DOB:		Height:
			Weight:

Driver Information

License Number:

State:

Exp:

Do you own a helmet?	Level of experience?	Make of Motorcycle?
Select Yes No	Select Beginner Intermediate Experienced	Select Harley Honda Kawasaki Suzuki Yamaha Other

Comments

Please note that we require a 7 day cancellation notice. If a 7 day notice is
not possible we will review on a case by case basis.

Mail payments to:
S.M.A.R.T Course
P.O. Box 60622
North Charleston, SC 29419