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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: ____________________________________________

E-mail Address: _______________________________________

Court Referred Yes No     County Referred by: ____________________

Class date choice:
3rd Thursday of the Month, 5:30pm - 9:30pm
    June 15, 2017
    July 20, 2017
    August 17, 2017
    September 21, 2017

4th Saturday of the Month, 8:30am - 12:30pm
    June 17, 2017
    July 22, 2017
    August 26, 2017
    September 23, 2017

Tuition fee: $65.00 (non-refundable)
Location: Minnesota Safety Council, 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: _____/_____ CVV2 Code: ________

Name on Card:_____________________________________________