Minnesota Safety Council: Alive at 25 Defensive Driving Course

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Alive at 25 Defensive Driving Course
Registration Form

Three ways to register:
Mail: MN Safety Council 474 Concordia Ave St. Paul, MN 55103	Phone: 651-228-7302 800-444-9150	Fax: 651-291-7584

Name: _________________________________________________________

Address: ________________________________________________________

City, State, Zip: __________________________________________________

Phone: _____________ Drivers License Number_______________________

Court Referred Yes No

County Referred by: _____________________________________________

Class date choice:
3rd Thursday of the Month, 5:30pm - 9:30pm
February 16, 2012
March 15, 2012
April 19, 2012

4th Saturday of the Month, 8:30am - 12:30pm
February 25, 2012
March 24, 2012
April 28, 2012

Tuition fee: $65.00 (non-refundable)
Location: Minnesota Safety Council Annex, 474 Concordia Ave, St. Paul, MN 55103

Payment must be received with registration one week prior to class Money order or credit card ONLY—no checks accepted
Money Order	Visa	MasterCard	American Express
Card Number:______________________Exp. Date_____/_____ Name on Card:_________________________________________