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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.
    August 17, 2017
    September 21, 2017
    October 19, 2017

Saturday, 8:30 a.m. - 12:30 p.m.
    August 19, 2017
    September 16, 2017
    October 21, 2017
    November 18, 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:_____________________________________________