1. Tell Us About Yourself

Name: __________________________________________________
                                 (first name, last name)
Address: ________________________________________________
City: _______________________ State: _____ Zip: ______________
Day Phone: (___)______________ Eve Phone: (___)______________
Email: ____________________________
Date of birth: ____________________________
  ___ Check here if under 18 years of age

Are you an Otis Air Force Base/Camp Edwards ANGB Employee or dependant?  __ Yes   __ No

2. Pick a Location ___ Bourne  __ Brockton  __Plymouth  __Framingham

3. Pick a Course ___ Basic    __ Experienced

4. Pick a Class Code

• Put two CLASS CODES below (i.e. CC1, CC2 - see our brochure or this website for class schedule and codes)
• When your registration is accepted, you will be mailed a confirmation letter that has detailed directions to the training site and reminds you of what you need to bring. You are not confirmed in any class until you receive this letter.

5. Determine Your Tuition

• $279 for Basic Rider Course
• $150 for Experienced Rider Course

Enter your credit card information here:
___ Mastercard     ___VISA    ___DISC    ___AMEX  (Check One)

Credit card number: ________ - ________ - ________ - ________   Expiration: _______

6. Complete and Sign

Do you have a hearing, reading or other type of disability?  __ Yes   __ No
Do you have a primary language other than English?  __ Yes   __ No
If you answered YES to any of the above questions, please call the office prior to registering to discuss if we can accommodate your special needs.

"I have read, understand and accept the Course Descriptions and Course Requirements pages of this website".

You must sign below or your registration is invalid.

7. SIGN THIS SECTION

Student signature: _____________________________________________

8. Mail Us This Form (to the address above) or FAX to (508) 247-9010