PFL 420 Registration

PFL 420 Registration Form

Fill out the form carefully for registration
Pick Class Date. Meeting Times are 8:30a-5:30p on all class offerings and all classes are offered simultaneously in person while streamed online. There is a limit of 6 spots available online. In-person students attend class at 430 Connell Rd, Valdosta, GA 31602. *
Deadline for class registration is 4p on the day before class. Registrations received after 4p on the day before the class will not be accepted.
Student Name*

First NameMiddle NameLast Name
In PersonVirtually via Microsoft Teams
Who is your probation officer?   *

Do you give permission to Redirect Counseling Services to send verification of your enrollment in this program, as well as completion or termination of this program to your Probation Officer?
Signature
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.
By signing below I agree to the terms and conditions.*

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My Products*

PFL 420 Class

PFL 420 is an 8 hour class, taught in-person, that focuses on high risk behaviors related to marijuana use.

$200.00

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

PFL 420 Registration Form