Minnesota Safety Council
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Alive at 25 Defensive Driving Course
Registration Form
Three ways to register:
Mail: Minnesota 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
August 21, 2014
September 18, 2014
October 16, 2014
November 20, 2014

4th Saturday of the Month, 8:30am - 12:30pm
July 26, 2014
August 23, 2014
September 27, 2014
October 25, 2014


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:_________________________________________