2014 Bootheel Motorcycle Training - BRC Application

 

Please the application, then mail to:††††††††††††††††††††††††††††††† †††††††††††††††

BMT

PO Box 134

New Madrid MO 63869

 

Print your name, as it appears on your driver's license.

 

Name                                                                                           Date of Birth                                  

 

Address                                                                                                                                                              

 

City, State & Zip                                                                                                                                                

 

Home Phone                                                 Cell Phone                                                    

 

Best time to reach you by phone                                                                                                                       

 

E-mail Address                                                                                                                                                     

 

Class dates:

Students are scheduled on a first come/first serve - prepaid basis. Early registration is suggested.

There are 2 classes per month and each class is 2 days in length.


April 5/6     April 26/27             May 3/4      May 17/18            June 7/8      June 28/29              

   July 19/20               August 16/17               September 20/21              October 4/5

 

Preferred dates: 1st choice:                               2nd choice:                               3rd choice:                              

 

Course fee is $200.00 per person Make checks payable to: BMT

Registrations within 7 days of class date require cashierís check, money order, credit card or cash. †††††† †††††††††††††††

Refund policy:

A refund, less a $10.00 processing fee, will only be issued for cancellations made MORE than 7days in

advance or in the event of an emergency. In the event of an unsuccessful completion, no refund will

be available.

 

By signing below, I signify that I have read and understand the refund policy.

 

Applicantís Signature: †††††††††††††††††††††† ††††††††††††††††††††††††††††††† †††††††††††††††   Date: ††††††††††††††††††††††††††††††† †††††††††††††††

 

**If under the age of 18:  Parentís Signature         ††††††††††††††††††††††