DirtBike Tech Registration Form

DirtBike Tech Registration Form

Please provide the following student information (* required fields):

First Name *

Middle Name

Last Name *

Birth Date *

Age *

Under 18? *

Gender *

Height (in)

Weight (lbs)

Inseam (in)

Consenting Adult (Required if under 18)

Attending Adult (Required for Youth DBS)

Address1 *

Address2

City *

Phone1 *

Phone2 *

Phone3

State *

Zip *

Email *

Emergency Contact Name

Emergency Contact Phone

Please tell us which course you'd like to register for:

1st Choice *

2nd Choice *

Bike Rental? *

Comments

Payment Amount *

Payment Type *

When you click Submit below, this will generate and send an email to Training@DirtBikeTech.com with all the information contained in this form. We will do our best to register you for the class of your preference. We will temporarily hold your spot in class until we receive your payment. Upon receipt of payment, we will send you a confirmation via e-mail.

** NOTE: If you wish to pay with a credit card, our preference is to send you an invoice via email using Paypal after you submit this registration form. If you wish to pay by check or money order: Complete the form, print it and send it along with your payment payable to DirtBike Tech. Send it to:

DirtBike Tech

PO Box 48957

Minneapolis, MN 55448