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
WINTER LESSON WAITLIST IS NOW OPEN

All in-car lessons/ services are full into FEBRUARY
PRIVATE LESSON REGISTRATION

No money is due when you register. You do not pay until we have found you a place on the schedule.

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 (if any); this helps us with scheduling
Please provide a clear and legible snapshot of the entire front of your permit/ license:
Birth Date

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

MonthDayYear
Permit/ license expiration date

MonthDayYear

WINTER LESSON WAITLIST IS NOW OPEN