Which 2019 course are you registering for? (Choose from list) * Click here and choose...Roanoke - June 28 (2 spots left)Roanoke - June 29 (SOLD OUT)Roanoke - June 30 (4 spots left)BMW RA Woodstock Sept 6 (4 spots left)BMW RA Woodstock Sept 7 (4 spots left)Waiting & Overflow List (Specify which date and event in Special Notes area)
First Name
Last Name
Address1
Address2
City
State
Zip Code
Date of Birth (MM/DD/YY) *
E-Mail *
Cell Phone
Home (Alternate) Phone
Emergency Contact Name
Emergency Contact Phone
Relevant Medical Info (bee sting allergies, asthma, etc.)
Make and model of motorcycle you’ll be using
Total Years of Riding Experience
Average Miles Ridden per Year
Approximate Lifetime Miles Ridden
What is your usual road riding pace? ComfortableBrisk at TimesIntense
What skills do you most want to work on? (Some choices: cornering confidence, situational awareness, smoothness, timing, braking, overall performance, etc.)
Do you have a valid motorcycle endorsement on your license? YesNo
How often do you have "close calls" when riding on the street? RarelySometimesFrequently
Your Driving Record is... Squeeky cleanA few blemishesThe traffic court judge knows me by name
You will have appropriate medical insurance at the time of the course? * YesNo
You agree to be responsible for damage to your motorcycle or property? * YesNo
Have you verified that your motorcycle is properly registered, insured and inspected? * YesNo
Have you properly assessed the operating condition of the motorcycle you will be using in this course, specifically lights, tires and brakes? YesNo
Are you a current AMA member? NoYes
AMA # if member
T-Shirt Size SMLXLXXL
How did you hear about Street Skills?
Special Notes, Questions or Names of those you wish to attend with:
Check box if you have a copy of Jon’s "Cornering Confidence" book
How many wheels does a motorcycle have? *
0 + 2 = ? Please prove that you are human by solving the equation *
