Contact Information:
First Name: (Required)
Last Name: (Required)
E-Mail Address: (Required)
Mailing Address:
City:
State:
Zip Code:
Home Phone:
Cell Phone:
Do you have a valid driver's license or learner's permit?
Yes No
Have you attended Cowley College?

Current Student
Previous Student
Never Attended

Are you a motorcycle owner?
Current
Previous
Never
Previous motorcycle experience:
Never been on a motorcycle
Passenger only
Driven off-road motorcycle only
Driven a street motorcycle
How did you hear about this course? (Check all that apply)
Newspaper
Radio
Poster
Internet
Family/Friend

Classes schedule preference for Basic RiderCourse:
1st choice: ..................................March 16, 17, 18March 30, 31, April 1April 20, 21, 22April 20, 28, 29May 18, 19, 20May 18, 26, 27June 15, 16, 17June 15, 23, 24July 13, 14, 15July 13, 21, 22
2nd choice: ..................................March 16, 17, 18March 30, 31, April 1April 20, 21, 22April 20, 28, 29May 18, 19, 20May 18, 26, 27June 15, 16, 17June 15, 23, 24July 13, 14, 15July 13, 21, 22
3rd choice: ..................................March 16, 17, 18March 30, 31, April 1April 20, 21, 22April 20, 28, 29May 18, 19, 20May 18, 26, 27June 15, 16, 17June 15, 23, 24July 13, 14, 15July 13, 21, 22
Classes schedule preference for Experienced RiderCourse:
1st choice: ..................................April 15July 1
2nd choice: ..................................April 15July 1
3rd choice: ..................................April 15July 1
Classes schedule preference for Additional RiderCourses:
Group Riding Seasoned Rider
Riding Straight
Intersections
Comments:

For the Basic RiderCourse and Experienced RiderCourse, by clicking the submit button, I agree and understand that I MUST provide appropriate clothing required for this course. I agree and understand that I MUST complete this course in it's entirety. If I miss any segments of the course (this includes being tardy), I will not be able to continue and I will have to register and pay for a new class to receive a certificate.

To finish the registration process, bring your valid driver's license to the Admissions office to complete the required state driver education form.