Class Registration Use this form to pre-register for the course of your choice. Please note: We need at least your permit/license ID number, name, address, phone number and a valid email address to make your registration. Please be assured, we will not use this information for any other purpose. Thank you in advance for considering us for your safe driving needs! Class sizes are limited and registration is on a first-come, first-served basis. If a course doesn't appear on the list, either it is closed or is not yet within a week of the class date. If you register and fail to show up twice, you will not be allowed to pre-register and must do a walk-in registration by showing up to the class. Class* 9/11/10 08:30AM - Jamestown (Hampton Inn) - Ins Pt Reduction ($35)9/12/10 08:30AM - Jamestown (Hampton Inn) - Pre-licensing ($30) You may register online or by phone for classes within 7 days of the course date ONLY. Please do NOT select a date other than the class you want to attend, or attempt to register more than 7 days before the class date. Select your desired class date above. Birth Date Eye Color BlueBrownBlackGreenGrayHazelViolet Permit or License?* Permit License Permit / License Number* Date Issued* Gender Male Female First Name* Middle Initial Last Name* Address* Apt # City* State* ZIP Code* Email* Daytime Telephone* Evening Telephone Cell Phone Fax # How did you hear about us?* Enter any comments in the space provided It's very important that you provide a valid email address. After you submit this form, you will receive a confirmation email from gss@germainesafety.com. If you don't receive the email within an hour, check your spam folder to see if it went in there. Click the "Send Registration" button to continue. '*' indicates required field