United Bicycle Institute
PRINTABLE CLASS APPLICATION
AND ENROLLMENT AGREEMENT
Schedule of Classes

This application form is intended to be printed, filled out, and mailed or faxed back to us. If you wish to register electronically, please use our secure Online Application.

Introduction to Bicycle Maintenance
(Tuition $675, Reg. Fee $100, Total $775)
Apr 28 - May 2, 2008
May 19 - May 23, 2008   		Jun 2 - Jun 6, 2008
Jul 21 - Jul 25, 2008   		Sep 8 - Sep 12, 2008
October 6 - 10, 2008   		Jan 26 - Jan 30, 2009
 

Introduction to Bicycle Maintenance for Women
(Tuition $675, Reg. Fee $100, Total $775)
Jun 23 - Jun 27, 2008        

Professional Repair and Shop Operation (Tuition $1450, Reg. Fee $150, Total $1,600)
Mar 3 - Mar 14, 2008
Mar 24 - Apr 4, 2008
Apr 14 - Apr 25, 2008
May 5 - May 16, 2008   		Jun 9 - Jun 20, 2008
Jul 7 - Jul 18, 2008
Jul 28 - Aug 8, 2008
Aug 18 - Aug 29, 2008   		Sep 15 - Sep 26, 2008
Oct 13 - Oct 24, 2008
Nov 3 - Nov 14, 2008
Dec 1 - Dec 12, 2008   		Jan 5 - Jan 16, 2009
 

Advanced Certification Seminar Week (Tuition $675, Reg. Fee $100, Total $775 Both Classes)
Mar 17 - Mar 21, 2008
Apr 7 - Apr 11, 2008   		Aug 11 - Aug 15, 2008
Sep 29 - Oct 3, 2008   		Oct 27 - Oct 31, 2008
Nov 17 - Nov 21, 2008   		Jan 19 - Jan 23, 2009
 
Please Choose Which Advanced Seminar Days:
Both Classes - 5 Days (Tuition $675, Reg. Fee $100, Total $650 includes $100 discount for both classes!)
 Monday and Tuesday: UBI/DT Certified Wheel Building (Tuition $350, Reg. Fee $50, Total $325)
 Wednesday through Friday: Certified Suspension Technician (Tuition $425, Reg. Fee $50, Total $425)
* Enrollment prerequisite for the Advanced Certification Seminars requires at least 1 year professional shop experience or
successful completion of a 2-week professional-level repair course.

Chromoly Brazing , Chromoly TIG Welding , Titanium , and UBI Alumni Week Frame Building
Mar 3 - Mar 14, 2008 Chromoly Brazing Frame Building Tuition $2150, Reg. Fee $150, Total $2300
Mar 17 - Mar 28, 2008 Chromoly TIG Welding Frame Building Tuition $2150, Reg. Fee $150, Total $2300
Apr 7- Apr 18, 2008 Chromoly Brazing Frame Building Tuition $2150, Reg. Fee $150, Total $2300
May 5 - May 16, 2008 Chromoly Brazing Frame Building Tuition $2150, Reg. Fee $150, Total $2300
Jun 9 - Jun 20, 2008 Titanium Frame Building Tuition $2850, Reg. Fee $150, Total $3000
Jul 7 - Jul 18, 2008 Chromoly Brazing Frame Building Tuition $2150, Reg. Fee $150, Total $2300
Jul 21 - Aug 1, 2008 Chromoly TIG Welding Frame Building Tuition $2150, Reg. Fee $150, Total $2300
Aug 11 - Aug 22, 2008 Chromoly Brazing Frame Building Tuition $2150, Reg. Fee $150, Total $2300
Sep 15 - Sep 26, 2008 Chromoly Brazing Frame Building Tuition $2150, Reg. Fee $150, Total $2300
Sep 29 - Oct 10, 2008 Chromoly TIG Welding Frame Building Tuition $2150, Reg. Fee $150, Total $2300
Oct 20 - Oct 31, 2008 Chromoly Brazing Frame Building Tuition $2150, Reg. Fee $150, Total $2300
Nov 10 - Nov 21, 2008 Chromoly Brazing Frame Building Tuition $2150, Reg. Fee $150, Total $2300
Dec 1 - Dec 12, 2008 Titanium Frame Building Tuition $2850, Reg. Fee $150, Total $3000
Jan 5 - Jan 16, 2009 Chromoly Brazing Frame Building Tuition $2150, Reg. Fee $150, Total $2300
Jan 19 - Jan 30, 2009 Chromoly TIG Welding Frame Building Tuition $2150, Reg. Fee $150, Total $2300

Specialty Courses - TIG Welding Seminars
Mar 15 - Mar 16, 2008 TIG Welding Seminar Tuition $375, Reg. Fee $50, Total $425
Apr 19 - Apr 20, 2008 TIG Welding Seminar Tuition $375, Reg. Fee $50, Total $425
Jul 19- Jul 20, 2008 TIG Welding Seminar Tuition $375, Reg. Fee $50, Total $425
Sep 27 - Sep 28, 2008 TIG Welding Seminar Tuition $375, Reg. Fee $50, Total $425
Nov 1 - Nov 2, 2008 TIG Welding Seminar Tuition $375, Reg. Fee $50, Total $425
Jan 17 - Jan 18, 2009 TIG Welding Seminar Tuition $375, Reg. Fee $50, Total $425

Please type or print clearly:

Have you previously attended UBI?   No, I am a new UBI student     Yes, I am a previous grad

Full Name:____________________________________________Date of Birth:_____________
 (as you would like it to appear on your certificate) 
If you prefer to use a nickname in class, please enter it here:___________________________
Address:________________________________________________________Apt #:_________
City:_________________________State:______Postal Code:____________Country:________
Home Phone #: (____)____________________ Work Phone #: (____) ____________________
E-mail Address (if applicable):_____________________________________________________
Who to contact in an emergency:______________________Phone Number:(____)__________
What is your occupation?_________________________________________________________
Have you previously attended UBI?   Yes   No    If so, which class(es)? _______________
What type of cycling activities have you been involved in?_______________________________
_________________________________________________________For how long?__________
Your primary cycling interests include (check all that apply):
Road Mountain Track BMX Racing Touring Commuting
What other mechanic's course, if any, have you taken? ________________________________
Please rate your prior mechanical experience (0=no experience, 5=extensive experience):____
How did you first hear about us?____________________________________________________
What are your goals in attending this course?_________________________________________
_______________________________________________________________________________
Is there anything else we should know that will help you achieve your goals at UBI?
_______________________________________________________________________________
_______________________________________________________________________________

Cancellation and Refund Policy:
You may cancel enrollment prior to the starting date by giving written notice to UBI via postal mail, fax, or e-mail. If receipt of a cancellation notice occurs within 5 business days of receipt of enrollment, you will receive a 100% refund of all fees paid. If receipt of a cancellation notice occurs after 5 business days of receipt of enrollment, up to the first day of class(es), a refund will be given minus the registration fee. In leau of forfeiture of the registration fee, you may request a one-time transfer of your registration to a future class if the request occurs at least two weeks prior to the start of the cancelled class, and it must be applied to a class scheduled within one year of the cancelled class, however, if a second cancellation occurs, the deposit will be forfeited. Once class(es) have begun, if you withdraw from class(es) prior to completion of 50% of the class, you may be entitled to a prorated refund depending on the day of withdrawal, minus the registration fee.

Please Read and Sign Below

Your tuition includes instruction, the United Bicycle Institute Student Handbook, use of facilities, tools and instructional materials. Please note, all tuition and registration fees are payable in U.S. funds only. This application must be signed and received by us with the required registration fees in order to be valid - no application can be processed via telephone.

I would like to apply for attendance to United Bicycle Institute. I am enclosing the appropriate registration fees in US dollars for each of the classes I have checked. I have thoroughly read the school brochure, including each course's desciption, and I have read and understand the terms of this enrollment agreement, including the cancellation and refund policy.

I further understand the tuition balance is due no later than the first day of class and if I am not present within one hour of the start of class, I will be considered a no-show and my place in class may be taken by an alternate student from the waiting list. If applying for any Advanced Certification Seminars, I have read the requirements for entrance and have met the prerequisites.

Signature (required for all students): ___________________________ Date __________
Signature of parent or guardian of minor: _______________________ Date__________
Signature of school official: ____________________________________Date__________

A registration fee is required to reserve your spot in each of the classes you enroll in. Your balance will be the tuition amount for your class(es) minus any down payment you may opt to pay. Tuition fee balances are due on or before the first day of class.
Payment Method:   Check   VISA   Master Card Registration and Tuition Fees

Credit Card #_____________________________ Exp.___________


Name on card (required): ___________________________________


Credit card signature (required): ______________________________
Registration Fees:

Optional Down Payment:

Total Enclosed:
$_______

$_______

$_______
Please Note: Upon receipt of your application and Registration Fee, we will send you an acceptance notice, a city map with the location of the school and lodging information. Payment is in U.S. funds only, by VISA, MasterCard, or check (made payable to United Bicycle Institute). Faxed applications must be paid by credit card. Print this form and mail or fax your completed application with Registration Fees to:
United Bicycle Institute
P.O. Box 128
Ashland, OR 97520-0128 		Phone: (541) 488-1121
Fax: (541) 488-3485
www.bikeschool.com

United Bicycle Institute is a state-licensed career school. Any inquiry regarding this contract may be made by contacting United Bicycle Institute at (541) 488-1121, or the Superintendent of Public Instruction, Oregon Department of Education, 255, Capitol NE, Salem, OR 97310-0203, or by calling (503) 378-5810. Bicycle technology is constantly evolving, therefore, UBI reserves the right to alter any course for the enhancement of its curriculum.


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