Please complete
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
SM
MOTORCYCLE SAFETY FOUNDATION RIDERCOURSES
SM
SM
SM
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.)
1
. 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.
SM
5. Motorcycles:
The OSU-OKC CSEP maintains a fleet of motorcycles to be utilized ONLY by the Basic RiderCourse
.
SM
Participants may utilize their personal motorcycle for the course with proof of liability insurance. Experienced RiderCourse
and 3-
SM
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.
SM
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