(Please list make, model, size, and length of time owned):
*4. Do you have any handicaps or physical limitation that might affect your coordination or your ability
to operate a motorcycle?
(Please describe):
*5. How did you learn about the course?
(Please list all that apply):
Course Information:
(Please select the "Course Name" with any Discount applicable, along with the "Class Date" you want from the drop down menus below.)
*Course Name:
*Class Date (See above Schedule):
*Terms and Conditions of Appalachian Rider Education Program:
Rider Courses are provided as a public service by the Tennessee Department of safety and Appalachian Rider Education Program. Using materials and Instructors certified by the Motorcycle Safety Foundation. Class hours are TENTATIVE and may vary, due to class size, rate of progression, and weather. By filling out the Online Registration Form and checking the box below, you are agreeing that you have read and understand the Terms and Conditions associated with signing up for a course offered by Appalachian Rider Education Program. All questions with an * are required to be answered. This is not a complete Registration form and you will be required to fill out a complete Registration Form on the first day of your class. This is so we are not asking for your Social Security number, Birth Date, Age, or Gender over the Internet.The Online Registration form is only available for those who wish to pay with a Credit/ Debit Card online. You MUST provide valid proof either by mailing or emailing us a copy before your class, or by showing us proof at your class to get any discount applicable. If you fail to do so you will be held responsible for the Discounted amount before Appalachian Rider Education Program will provide services. To avoid forfeiture of fees you must notify us of any Schedule changes at least 5 working days prior to Scheduled class. All fees are Non-Refundable.
**Once you hit the submit button you will be taken to a "Thank You" page and asked to pay with your Credit/Debit card.
2012 Online Student Registration Form
Directions:
1. Fill out all questions
2. Hit the "Submit" button at the bottom when finished.
3. You will be directed to a Thank You Page. Click the "Pay Now" button to pay with your Credit/Debit card
selecting the class with any discount applicable. You will be directed to the PayPal site which will finish your
order. (You do NOT need a PayPal account to pay with your Credit/Debit card.)
4. Please know that we truly Appreciate YOUR Business and Interest in Appalachian Rider Education Program.
Click to Print the Registration Form & Information Sheet above or use the Interactive Registration Form above to fill it out in Excel. Fill the form out completely. Then mail the completed registration form with check to:
