2014 Bootheel Motorcycle Training - BRC Application


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


PO Box 134

New Madrid MO 63869


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


Name                                                                                           Date of Birth                                  




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         ††††††††††††††††††††††