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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:
Thursday, 5:30 - 9:30 p.m.
    December 21, 2017
    January 18, 2018
    February 15, 2018
    March 15, 2018
    April 19, 2018
    May 17, 2018

4th Saturday of the Month, 8:30 a.m. - 12:30 p.m.
    November 18, 2017
    December 16, 2017
    January 20, 2018
    February 17, 2018
    March 17, 2018
    April 21, 2018

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:_____________________________________________