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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: _____________________________________________

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.
    March 7, 2017
    April 4, 2017
    May 2, 2017
    June 6, 2017
    August 1, 2017

Saturday, 8:30 a.m. - 12:30 p.m.
    February 18, 2017
    March 18, 2017
    April 22, 2017
    May 20, 2017
    June 17, 2017

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: _____/_____ CVV2 Code: ________

Name on Card:_____________________________________________