EXTRA
Safe And Sober Registration Form
To Register for Drivers ED
To Register for Driver Improvement (DIP)
To Register for Safe & Sober (3hr Drug & Alcohol)
IMPORTANT INFORMATION:
Please call our school prior to registering to find out the date and time the safe & sober class is being offered.
Silver Spring Driving Academy
2424 University Blvd Ste 200
Silver Spring, MD 20902
Tel: 301-933-7913 Fax: 301-933-7914
The all following fields for student are required!
STUDENT'S INFORMATION
Today's Date:
First Name:
Last Name:
Middle Name:
(if any)
D.O.B:
(mm/dd/yyyy)
Street Address:
City:
Zip:
State:
MD
VA
DC
County:
Home Phone:
Cell Phone :
Email:
Work Phone :
Class you wish to register for:
Date:
Time:
How did you hear about our driving school?
Select one
YELLOW PAGES
INTERNET
YAHOO
GOOGLE
AOL.COM
HIGH SCHOOL NEWS PAPER
FRIENDS
FLYERS
FAMILY MEMBER
PAS SED BY
OTHER
Comments:
