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School Use Only:

Oklahoma State University – Oklahoma City

CWID#_______________

registration form,

Center for Safety and Emergency Preparedness

Receipt _______________

Motorcycle Driver Training

sign and mail in

Signature______________

Physical Address: 3501 West Reno Avenue

yellow portion with

Fee Paid ______________

Mailing Address: 900 North Portland

a copy of your

Method of payment

Oklahoma City, Oklahoma 73107

______________________

driver license OR

Phone: (405) 945-3208 FAX: (405) 945-8647

Date_____/______/______

Birth Certificate.

Registration and Contract for Motorcycle Driver Training

Copy of Driver’s License required at time of enrollment

R C P

SCT Chr

Full Name: __________________________________________________________________________________________________

First

Middle

Last

Address: ____________________________________________________________________________________________________

City, State & Zip: ________________________________________________Home Phone:__________________________________

Cell Phone: _____________________________________Email:_______________________________________________________

Age: _______________ Date of Birth: ___________________________ (Must be 14 years of age or older to participate. If under

the age of 18, a parent or legal guardian must sign a waiver form, prior to attending. A copy of a birth certificate is also required)

I authorize OSU-OKC to release the following information contained in the educational records maintained by OSU-OKC to the

Oklahoma Department of Public Safety upon completion of the course:

1.) Participants Full Name

2.) Date Of Birth

3.) Driver’s License Number

This information is required by the State of Oklahoma in order to issue an “M” endorsement on the participants Driver’s License. Sign to indicate

you agree to OSU-OKC releasing this information.

________________________________________________

___________________________________

Participant Only

Date

MOTORCYCLE SAFETY FOUNDATION RIDERCOURSES

Basic RiderCourse

Experienced RiderCourse

Co-Rider Course

3-Wheel Course

Cost: $225.00

Cost: $125.00

Cost: $35.00

Cost: $225.00

Course Date: ________________________

(Class enrollment is pending availability. Please see enclosed schedule for class dates.)

. Payment: Payment is due upon enrollment. If returning by mail, send check with completed form and copy of driver license

to: OSU-Oklahoma City, CSEP, 900 N. Portland, Oklahoma City, OK 73107. Payment can also be made over the phone with credit

card or in person at 3501 W. Reno Ste. 100. There will be a $25.00 charge assessed to all returned checks.

2. Refunds: A $15.00 administrative fee will be charged for all refunds. To be eligible for a refund, cancellation notices must be

received 48 hours prior to class start date.

3. Location: The class will be held at the OSU-OKC Public Safety Training Center at 3501 W. Reno.

4. Operation: OSU-OKC CSEP agrees to operate and conduct the school in accordance with rules for Commercial Driver Training,

Department of Public Safety.

5. Motorcycles:

The OSU-OKC CSEP maintains a fleet of motorcycles to be utilized ONLY by the Basic RiderCourse

Participants may utilize their personal motorcycle for the course with proof of liability insurance. Experienced RiderCourse

and 3-

Wheel Basic RiderCourse

participants are required to provide their own motorcycle for training and are responsible for fuel,

lubricants, and insurance.

6. Contract: This instrument contains the entire contract between parties and no changes or amendments thereto shall be binding

upon the parties, unless made in writing.

7. Effective January 1, 2008, the use of tobacco products including cigarettes, cigars, pipes and smokeless tobacco shall be prohibited

anywhere on campus, including buildings, grounds and parking lots leased, owned or operated by OSU-Oklahoma City.

Note: All motorcycle RiderCourses

require the operator have proper riding gear, which includes helmet, eye protection, full-

fingered rider gloves, long-sleeve shirt or jacket, long pants and over the ankle boots. Gear must be worn at every session. (boots

with leather soles are not recommended.) No student will be allowed to ride any portion of the course without all of the listed

items.

_________________________________________________________________________________________________

OSU-OKC Precision Driving Training Center Representative

Date

____________________________________________

__________________________________________________

Participant

Date

Parent or Legal Guardian (if under 18)

Date

Registration And Contract For Motorcycle Driver Training - Oklahoma State University - Oklahoma City - Center For Safety And Emergency Preparedness Motorcycle Driver Training Form

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