Motorcycle Safety Registration Form – Glen Oaks Community College

Name: *

First Middle (Full) Last

Address: *

Street Address City State ZIP Code

Age: *

Email: *

Phone: *

Driver License #: *

Birth Date: *

A copy of your Driver License is required to register for a Motorcycle Safety Course. Please attach below: *

If you do not have a scanner, you may need to use one available through the Glen Oaks library, your public library, or through a retail establishment that offers a document scanning service.

Please select the class that you would like to register for: *

BRC: August 29th (0 spots left)
BRC: September 19th (0 spots left)
BRC: September 12th (0 spots left)
RRC: September 26th (0 spots left)
BRC: September 13th (0 spots left)

The BRC start on either a Saturday or Sunday morning, depending on what date you signed up for, both classes start at 7:00 am ending at 5:00 pm. The September 26th RRC course will take place on Saturday from 8:00 am to 5:00 pm.

If the course you desire to sign up for has no spots left, you will need to select another course date/time or continue to check back to see if anyone from the filled course has dropped.

Will you be paying your registration fee yourself? *

Yes
No

If not, please list the name of the individual who will be paying your registration fee:

Do you intend to pay the registration fee for another applicant?

Yes
No

Name of the additional applicant(s) whose registration fee you will be paying (besides yourself):

Please select the class(es) that the person(s) you are paying for has enrolled:

BRC: August 29th
BRC: September 19th
BRC: September 12th
RRC: September 26th
BRC: September 13th

Email

This field is for validation purposes and should be left unchanged.