Wisconsin Registration Form

Student Name (First, Last, MI)(required)

Home Address, City, Zip(required)

Phone Number(required)

Email(required)

Student Birthdate(required)

Driver License Number(required)

Gender

School Use: Contract Agreement, Enrollment Date, Instructor Initials

Who can we thank for referring you to the Transportation Safety Foundation?(required)

This agreement constitutes the entire agreement between the school and the student and no verbal statement or promises will be recognized. I understand that the course must be completed within 7 days of receipt of this form and payment. I understand that all course information will be released after payment has been received. I understand that if course is not completed within 7 days the course will expire and not refund will be issued. (Please print name to acknowledge.)(required)

(Any payments that require a refund or reimbursement will be assessed a $35 fee.)

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