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Registration Page Rider's Edge® New Rider course

Please complete the form below to get the Rider's Edge® New Rider course enrollment process started.
All information you provide online is secure and confidential.
We'll contact you by phone at the number you provide to confirm the dates of your class.

Or, if you would rather provide this information over the telephone,
please feel free to call us at (608)221-2761 Ext. 115.

First Name: Last Name:

Street Address:

City: State: Zip Code:

E-mail Address: Daytime Phone with Area Code:

Evening Phone:

Best Time to Call: How should we contact you?

Gender: Male Female Height:

Date of Birth: Driver License Expiration:
mm/dd/yy format Please

Driver License Number: Motorcycle Endorsement: YesNo

License State: Motorcycle Permit Expiration:

Learner's Permit: Yes No Are you a motorcycle owner? Yes No

How interested are you in buying a Harley® Motorcycle?

How interested are you in buying a Buell® Motorcycle?

Motorcycle Experience

Can you ride a bicycle? Yes No

Have you taken a beginner motorcycle safety course before? Yes No

Any medical, physical limitations that may affect your ability to ride.

Describe your Motorcycle Riding Experience: (select the one that best describes you)
	I have never been on a motorcycle before (even as a passenger).
	I have ridden only as a passenger.
	I have ridden an off-road motorcycle (dirt bike, trail bike, etc.) but never a street motorcycle.
	I have ridden a street motorcycle.