M2 Exit Registration Form

Motorcycle Training Course
M2Exit Course Registration Form
(Permanent Licence)

(Waiver of Claim Form must accompany registration)

M2Exit Course Location: (check one)		Peterborough - $389.00
		Kingston - $395.16
		Whitby - $399.00
		Ottawa - $399.00

Course Date:

Preferred

____/____/____

Alternate

____/____/____

Name:

_____________________________________________

Address:

_____________________________________________

City:

_____________________________________________

Postal Code:

______-______

Telephone:

Day_____________________ Night____________________

Date of Birth:

___________________________

Method of Payment

Cheque

Visa

MasterCard

Money Order

Card Number:

__________-__________-__________-__________

Expiry Date:

____/____
(month/year)

Signature:

_____________________________________________

Date:

____/____/____

Print out this form and the Waiver of Claim Form and then choose your method of registration - Telephone - Mail - Fax.

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