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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/time choice:
  Thursday, March 21, 2019 | 5:30 - 9:30 p.m.   Saturday, March 16, 2019 8:30 - 12:30 p.m.
  Thursday, April 18, 2019 | 5:30 - 9:30 p.m.   Saturday, May 18, 2019 | 8:30 - 12:30 p.m.
 Thursday May 16, 2019 | 5:30 - 9:30 p.m.   Saturday, June 15, 2019 | 8:30 - 12:30 p.m.
 Thursday June 20, 2019 | 5:30 - 9:30 p.m.   Saturday, July 20, 2019 | 8:30 - 12:30 p.m.
 Thursday July 18, 2019 | 5:30 - 9:30 p.m.   Saturday, August 17, 2019 | 8:30 - 12:30 p.m.
 Thursday August 15, 2019 | 5:30 - 9:30 p.m.   Saturday, September 21, 2019 | 8:30 - 12:30 p.m.
 Thursday September 19, 2019 | 5:30 - 9:30 p.m.  

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:_____________________________________________