Advanced Driving School

Online Form

Collinsville Remedial Course Date

March 17, 2012 $100.00 USD

Students Name

Here you will be able to pay & register then submit your registration for our remedial course. By paying and submitting this form online you will have a seat reserved in the class you are signing up for. If you have any questions Please call 618-345-1919.

Contact Form

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First Name:*

Middle Initial:

Last Name:*

E-Mail Address:*

Street & Address*

City*

State & Zip Code*

Date of Birth*

Driver License Number*

Contact Number*

Class Date Attending*

I understand no make up classes will be offered if I show up late or don't show for this class date and my payment will automatically be forfeited.*

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