Cornering Confidence Registration Form – Street Skills LLC Which course are you registering for? (Choose from list) * Click here and choose... Trail Braking Camp Coaching Tour Track Event First Name Last Name Address1 Address2 City State Zip Code Age * E-Mail * Cell Phone Home (Alternate) Phone Emergency Contact Name Emergency Contact Phone Relevant Medical Info (bee sting allergies, asthma, etc.) List any physical limitations you have riding a motorcycle (if applicable) Make and model of primary motorcycle(s) Your Height (Important only for trail braking camp bike fitment) Your Approx. Weight (Important only for trail braking camp bike fitment) Gender Total Years of Riding Experience Average Miles Ridden per Year Approximate Lifetime Miles Ridden What is your usual road riding pace? Comfortable Brisk at Times Intense
Do you have a valid motorcycle endorsement on your license? Yes No How often do you have "close calls" when riding on the street? Rarely Sometimes Frequently Your Driving Record is... Squeeky clean A few blemishes The traffic court judge knows me by name You will have appropriate medical insurance at the time of the course? * Yes No You agree to be responsible for damage to your motorcycle or property? (If applicable) * Yes No n/a Have you verified that your motorcycle is properly registered, insured and inspected? (If applicable) * Yes No n/a Have you properly assessed the operating condition of the motorcycle you will be using in this course, specifically lights, tires and brakes? (If applicable) Yes No n/a Are you a current AMA member? No Yes AMA # if member T-Shirt Size S M L XL XXL How did you hear about Street Skills’ Cornering Confidence Program?
Check box if you have a copy of Jon’s "Cornering Confidence" book
Check box if you’re already enrolled in the "Cornering Confidence" online course. How many wheels does a motorcycle have? *
1 + 3 = ? Please prove that you are human by solving the equation *