Registration Form

District 3 / Douglas

Starts:

Saturday, April 6, 2024

Location:

Champagne Creek Ranch
10T 460844E, 4782898N
Roseburg, OR

Price:

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

Contact:

Mandi Parker

Phone: 541-784-6206
Email: mandyparker@gmail.com

4-6 Motorcycle and ATV Evaluation

Youth Off-Road Evaluation for Motorcycles and ATV's Saturday 11:00 AM Bring youth's motorcycle or ATV 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 Mandi 541-784-6206

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