Registration Form

District 5 / Deschutes

Starts:

Saturday, November 19, 2016

Location:

John Lynch property
63210 Deschutes Market Rd
Bend, OR 97701

Price:

In State: $20.00/youth
Out of State: $75.00/youth

Contact:

John Lynch

Phone: 541-420-6943
Email: johnlxcfw@gmail.com

11-19 Youth Evaluation

Youth Off-Road Evaluation. MOTORCYCLES ONLY

Saturday, 12:00PM start. Bring the youth's motorcycle and appropriate riding gear.

Oregon residents $20.00 Out of state residents $65.00

Kids must have completed the online test ( http://www.rideatvoregon.org/ ) and register here with their child's 11-digit Safety Ed number from the online test.

For question contact John 541-420-6943

Parent's Information

Parents

Please enter your contact information so we can reach you.

Make sure you use your most current email address so we can email you a copy of your registration and a receipt of payment.

Phone numbers are required so we may contact you via phone.

Parent's First Name

Parent's Last Name

Day Phone

Evening Phone

Email
Email is required for registration confirmation.

Mailing Address

Address

City

State

Zip Code

Physical Address

Address

City

State

Zip Code

Youth #1

Youth Information

All youth information is required to process your registration.

Please double check to see you have entered accurate information for this youth.

Registration Type Class 1 (ATV) Class 3 (Motorcycle)

First Name

Last Name

OASE # Oregon ATV Safety Education Card Number

Date of Birth

(mm/dd/yyyy)

Add Youth

Need to register more than one youth?

Miscellaneous

I would like to receive more OHV Action information.

Billing Information

The billing information you provide here must match the billing information on the credit card you're planning to use below.

First Name

Last Name

Address

City

State

Zip Code

Phone

Promo Code

Code

Payment Information

We accept

Card Type

Number

Code

Expiration / Enter in the format: mm/yy

Order Information

Subtotal

1 @ 20/youth

Total

$0.00

Verification