PRIVATE LESSON REGISTRATION

2800 W Broad St #611, Athens GA 30606

BY APPOINTMENT ONLY

elly@athensdrivingprep.com

www.athensdrivingprep.com

(706) 850-2800

LIC# LDT-710
REGISTRATION IS CLOSED. DO NOT REGISTER AT THIS TIME, IT WILL NOT BE RECEIVED. REGISTRATION WILL REOPEN IN MID-OCTOBER FOR WINTER LESSONS.
PRIVATE LESSON REGISTRATION
REGISTRATION IS CLOSED. THIS FORM WILL NOT REACH ANYONE’S INBOX.

Student Information
Legal Name (as it appears on your permit/ license)*

First NameMiddle NameLast Name
Preferred name to be called*
Student Email *
Phone Number
Address*

Street Address

Street Address Line 2

City and Zip CodeState / Province

Postal / Zip Code
School currently attending (this helps with scheduling)
Either take a photo of your permit/ license, OR fill in its information below:
Birth Date

MonthDayYear
Permit/ license Number
e.g. 11183021
Permit/ license issue date

MonthDayYear
Permit/ license expiration date

MonthDayYear

REGISTRATION IS CLOSED. DO NOT REGISTER AT THIS TIME, IT WILL NOT BE RECEIVED. REGISTRATION WILL REOPEN IN MID-OCTOBER FOR WINTER LESSONS.