Minnesota Safety Council: Court-Referred Defensive Driving Course Registration Form

Print this form and mail or fax it in at least one week prior to class.

Court-Referred Defensive Driving Course Registration Form

Three ways to register:
Mail: MN Safety Council 474 Concordia Ave St. Paul, MN 55103	Phone: 651-228-7306 or 800-444-9150, ext. 306	Fax: 651-291-7584

Name:____________________________________________________________

Address:__________________________________________________________

City, State, Zip:_____________________________________________________

Phone:_________________Drivers License Number________________________
Class location/date choice:
Crystal
4th Tuesday of the month
St. Paul
2nd Saturday of the month
3rd Saturday of the month
Saint Paul College
Thursday, October 16, 2008
Thursday, November 20, 2008
Thursday, December 18, 2008
Minneapolis
4th Saturday of the month

Weekday classes: 5:30PM-10:00PM
Saturday classes: 8:00AM-12:30PM
Tuition fee: $65.00 (non-refundable)

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:_____________________________________________