LIBMSP Training Registration

Please Take Your Photo

Name

First NameLast Name

Birth Date

Date

Email Address

example@example.com

Gender:

MaleFemaleOther

Nationality:

Business Name

Organization/Memberships

Have you attended this training before?

YesNo

If yes, when?

Do you own a motorcycle?

YesNo

Motorcycle Make and Model:

Motorcycle License Plate Number:

Color

Which Dealer was it purchased from

Are you already driving a motocycle?

YesNo

If yes, How Long

How did you learn to ride: ( please explain the area and condition)

Preferred Training Location:

Preferred Training Date:

WeekdaysWeekend DaysOdd Days

If odd Days, please specific Days

Preferred Training Time:

MorningAfternoonEvenings

Do you have any medical conditions that might affect your training?

YesNo

If yes, please specify or explain:

Information Here:(Name, Relationship, Phone; Email; City or Town; Community, Place of work if available)

Training Registration