ALIVE AT 25 TEEN 4 HOUR Defensive Driving Classroom
Course Registration
Acceptance of ONLINE Refund/Cancellation
Type full initials of submitting individual
Driver License Number
State Driver License was issued in
Legal FIRST Name
Legal Middle Name
Legal LAST Name
Email Address
Phone Number with area code
Date of Birth (MM/DD/YYYY)
Current Age
Street Address
Apartment number (if applicable)
City, State, Zip
Date(s) of Class
Purpose for Taking Class
County Where Ticket was Issued
Court Where Ticket was Regulated
Payment of Registration?
All registrations must be accompanied by a full payment of tuition.  Please proceed to
"PAY ONLINE" page of this website, or make arrangements to come in to the school
before class begins to present payment.