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Ramsey County Referral Program
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____________________

E-mail Address: _________________________________________________________

Tuition fee: $85.00 (non-refundable)
Location: Minnesota Safety Council, 474 Concordia Ave, St. Paul, MN 55103

Class date choice:
Tuesday, 5:30 - 9:30 p.m.
    September 6, 2016
    October 4, 2016
    November 1, 2016
    December 6, 2016

Saturday, 8:30 a.m. - 12:30 p.m.
    August 20, 2016
    September 17, 2016
    October 15, 2016
    November 19, 2016
    December 17, 2016

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:_________________________________________