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
WINTER LESSONS ARE FULL
We are not currently accepting new students.
Registration for spring lessons will open in late February.
If you fill out the registration form now, it will not be received. It will go to spam.
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

REGISTRATION IS CLOSED