Name:______________________ Address:______________________________
Age:_______
City, state, zip: ______________________________
Phone number:__________________ E-Mail:________________________
School date:__________
Bike size:_____ Make:_______ Model:_____________
Years of riding experience:________ Birth date:__________
Are you an OPMC member? Yes
No
How did you hear about the school?
q EW MX school website
q Friend _____________
q
Bike Shop: What shop?_____________
q Other ____________
Send to:
Eric Waunch
Bothell, WA. 98012