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Motorcyle Insurance
 

New Student Sign Up


Email Address * :
you will need this e-mail address to login and view and/or change all your information in the future
Password * :
case sensitive 6-20 characters
Retype Password * :
 
First Name (Must be the same as on Driver's License)  * :
Middle Name/Initial (Must be the same as on D.L.) :
Last Name (Must be the same as on D.L.) * :
Street Address * :
do not enter appartment or suite number here, only the regular street address
 
use this field to enter appartment or suite number, or other relevant additional address information
City * :
State * :
Zip * : -
Country * :
Home Phone * : () - ext. primary telephone number
Cell Phone : () - ext.
 () - ext.
 
Date of Birth * : ( MM-DD-YYYY )
Age * :
Gender * :
 
Login Question :
in case you forget password
Login Answer :
 
In Case of Emergency call: (ENTER NAME) * :
Enter name of emergency contact
Emergency Contact: (ENTER PHONE NUMBER) * :
Can you ride a bicycle? * : Yes No
When was the last time you rode a bicycle? * :
Previous motorcycle experience? * :  
 
Type (brand) of motorcycle(s) / scooter(s) owned? * : State whether it is a motorcycle or scooter and then enter brand(s) and engine size(s) for each vehicle
 
Height * :
ie: 5'6"
Do you have any physical conditions
which we need to be aware of when you are on the motorcycle? * :
 
 
Drivers License State/Country * :
Drivers License: (ENTER NUMBER) * :
Who referred you to RMMT? * :
Motor scooters are available. Do you plan on training on one of RMMT's motor scooters?  * : Yes No (Please be advised that we only have one motorscooter per training site. )