WALLA WALLA COUNTY DUI VICTIM'S PANEL Registration

REGISTRATION

DUI VICTIM IMPACT PANEL

WALLA WALLA VALLEY

54 E MOORE ST, WALLA WALLA, WA 99362

(509) 525-3342

INFO@WWACW.COM
REGISTRATION - DOORS OPEN AT 6:30PM. YOU MAY SIGN IN AT ANY TIME BETWEEN 6:30PM AND 7:00PM

YOU MUST BE SIGNED IN BY THE BEGINNING OF CLASS AT 7:00PM TO ATTEND CLASS.

PANEL WILL CONCLUDE BY 8:30PM.

IDENTIFICATION REQUIRED.
Attendee Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code
E-mail*
example@example.com
Contact Number*
Format: (000) 000-0000.
Name of Court/Agency that ordered you to attend the DUI Victim Impact Panel*
Court/Agency Location*

Street Address Line 2

CityState / Province

Postal / Zip Code
Court Case #
The DUI Victim Panel is offered every other month. *
You must be registered and paid prior to the class.
YesNo

Registration Fee*

Registration Fee

$45.00

Cash - Pay Night Of

You are agreeing to pay cash at registration that night of event. CHECKS WILL NOT BE ACCEPTED.

$45.00

Total

$0.00

Credit Card

Apple Pay

Google Pay

No guests or children allowed without prior approval.

All hats and dark glasses need to be removed.
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