Register BRC – RidingSafety.com

BRC Registration Form

DO NOT submit this form unless you
have already paid for the
BRC (Basic Rider Course)

Submitting this form will complete your registration.
RidingSafety .com requests none of the
information below is released or shared outside program.

BRC Registration Form

Name: Last, First, MI *

Email- If Active Duty supply Mil email *

Military-Use Military email here for 2 WingSafety

Date of Birth MM/DD/YY *

License info: STATE & NUMBER (EXAMPLE: LA 9999999) *

Complete address (incl. CITY STATE & Zip) is on your license currently? (We are not asking for your actual address) *

The Louisiana Office of Motor Vehicle requires RidingSafety.com to submit your complete address as it appears on your current license (incl city, state & zip) when we submit your skill test score. This will waive testing at the Office of Motor Vehicle for the State of Louisiana licensing.

Cell phone number *

RidingSafety only uses the phone information to communicate with YOU. By contract, RidingSafety CAN NOT / WILL NOT release or share this information to third parties

Other Info: What class date & time? What name do you go by?

If there is anything you would like to share with us; incl class choice & NAME you would like to be called in class (Nickname).

Please choose the BEST description of your riding experience:

I am a new rider
I was a rider, but have not ridden recently
I am a rider, with over 2,000 miles ridden in the last year

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