Defensive Driving Registration

Defensive Driving Registration Form

Fill out the form carefully for registration. In-person students attend class at 430 Connell Rd, Valdosta, GA 31602. Students must arrive at or before 9am the day of class to attend. Online students must log in to the Microsoft Teams meeting by 9am on the day of their class to attend.
In PersonVirtually, Online
Pick In Person Class Date*
Registration closes at 4pm the day before class. If you complete this registration form after the closing time for the program, you will not be registered for the class.
Pick Online Class Date*
Registration closes at 4pm the day before class. If you complete this registration form after the closing time for the program, you will not be registered for the class.
Student Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Driver's License Number or SSN*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student E-mail*
example@example.com
Mobile Number*
Format: (000) 000-0000.
ReInstatementPointsInsuranceOther
By signing below I agree to the Terms and Conditions in the Defensive Driving Course contract. *

Clear

My Products*

Defensive Driving

Defensive Driving Course is a DDS certified course that lasts 6 hours. It is taught in person.

$95.00

Total

$0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Defensive Driving Registration Form