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 Form 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: Watch your email for a PayPal invoice for the amount due. You can pay electronically by several different methods OR if you prefer to pay by Check via US Mail. Please send your check to;

DirtBike Tech

PO Box 185

Anoka, MN 55303

Upon receipt of your payment, we'll send you a message confirming your spot in the class and provide you with additional important class information.