North Sound Safety    P.O. Box 2566    Mount Vernon, Wa 98273    Phone: 1.360.424.7136    Fax: 1.360.424.7084    E-mail: info@northsoundsafety.com

(BRC) The Basic Rider Course is tailored to provide the basic skills and techniques, both mentally and physically needed, to ride a motorcycle, safely. All Students under the age of 18 years old will need to have the instructor witness a parent/guardian signature on a waiver before they are able to ride any of our motorcycles. Consent will be given on the Waiver of Release of Liability. ALL STUDENTS must sign a Waiver of Release of Liability.
(ERC) The Intermediate Experienced Rider Course is a one day rider course providing participants the opportunity to improve riding skills, on your own motorcycle. All Motorcycles are required to be in good working order and street legal. Participants must have a minimum of 3000 miles plus 90 days of riding experience, and a motorcycle learner's permit or endorsement to enroll. Please be prepared to show license and proof of insurance to the instructor.

Name (Last, First, Middle)	Class Date	Class Number
Address	City	State	Zip
Drivers License Number                                        State	Birthdate	Phone#
Emergency Contact Name                                                                          Phone#

Type of bike owned?	CC Size	How long have you been riding?	Number of miles ridden in the past year?	Have you ever been involved in a motorcycle accident?
		______Years_____Mo	_____________On Road _____________Off Road	Yes No

TUITION FEE and PAYMENT:
(BRC-N) BASIC RIDER COURSE NON-SUBSIDIZED BY THE STATE OF WASHINGTON REGULAR PRICE TUITION $205.00, with Washington state drivers license, or active duty military and dependents, and for out of state license holders.
(BRC-S) BASIC RIDER COURSE SUBSIDIZED BY THE STATE OF WASHINGTON, WHEN AVAILABLE TUITION IS $125.00 with Washington State Drivers License, or active duty military and dependents.
Students under 18 years of age with a Washington State Drivers License, tuition is. $50.00
(ERC) INTERMEDIATE EXPERIENCE RIDER COURSE: TUITION IS $125.00


Please Include Class Number On payment payable to: NORTH SOUND SAFETY. You are not officially registered until payment is received and confirmed. Once confirmed there will be NO REFUNDS. PLEASE COMPLETE AND RETURN FORMS TO ADDRESS ABOVE.

Credit Card# Visa or MC#	Card Type	Expiration	Office Use
Credit Card Billing Address:

Part 2 (Liability)