Print this form and mail or fax it in at least one week prior to class.

Court-Referred Defensive Driving Course Registration Form

Three ways to register:
Mail: MN Safety Council
474 Concordia Ave
St. Paul, MN 55103
Phone: 651-228-7308 or
800-444-9150, ext. 308
Fax: 651-291-7584


Name:_______________________________________________________

Address:_____________________________________________________

City, State, Zip:________________________________________________

Phone:_________________________________

E-mail Address:_______________________________________________

Class location/date choice:
Saint Paul
May 9; 8:30 a.m. - 12:30 p.m.
June 13; 8:30 a.m. - 12:30 p.m.
July 11; 8:30 a.m. - 12:30 p.m.
August 8; 8:30 a.m. - 12:30 p.m.
September 12; 8:30 a.m. - 12:30 p.m.
October 10; 8:30 a.m. - 12:30 p.m.
November 14; 8:30 a.m. - 12:30 p.m.
December 12; 8:30 a.m. - 12:30 p.m.


Tuition fee: $65.00 (non-refundable)

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:_____________________________________________