School location____________________________________  Date: ____________________


Name: __________________________________________________________________________


Address: __________________________________________________________________________

     
City:   ______________________________________    State__________ Zip____________


Phone:   _______________________    Mobil : _________________Work: ______________


e-mail:    __________________________________________           Age: _______________


Parents or guardians names (if under 18) __________________________________________________________________________


Years riding experience: ________________ Current racing class:_____________________


Motorcycle(s) currently owned: __________________________________________________________________________

What do you intend to accomplish at this school?  (please be specific)

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

How did you hear about MX COACH?   __________________________________________________________________________

__________________________________________________________________________

What, if any, are your future desires for racing? 

__________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

Mail to:        MX COACH

Please include a check or money order for at least 50% of the tuition.  Any remaining balance
must be paid in full 10 days prior to your school date.