Local Class Registration Form 2024-2025 District/Driver InformationSchool District/Employer* Billing Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Supervisor Name* Supervisor Cell Phone Number*Supervisor E-mail Address* Enter Email Confirm Email Class Attending, MUST ATTEND FIRST DAY OF CLASS!*January 6-9 @ FremontJanuary 13-16 @ LimaJanuary 20-23 @ Hancock County ESCJanuary 27-30 @ Archbold Number of Pre-Service Drivers Attending | Monday thru Thursday*Please enter a number from 0 to 20.Driver 1*First NameLast NameDriver 2*First NameLast NameDriver 3*First NameLast NameDriver 4*First NameLast NameDriver 5*First NameLast NameDriver 6First NameLast NameDriver 7First NameLast NameDriver 8First NameLast NameDriver 9First NameLast NameDriver 10First NameLast NameDriver 11First NameLast NameDriver 12First NameLast NameDriver 13First NameLast NameDriver 14First NameLast NameDriver 15First NameLast NameDriver 16First NameLast NameDriver 17First NameLast NameDriver 18First NameLast NameDriver 19First NameLast NameDriver 20First NameLast NameNumber of Re-certification Drivers Attending | Tuesday thru Thursday*Please enter a number from 0 to 20.Driver 1*First NameLast NameDriver 2*First NameLast NameDriver 3*First NameLast NameDriver 4*First NameLast NameDriver 5*First NameLast NameDriver 6First NameLast NameDriver 7First NameLast NameDriver 8First NameLast NameDriver 9First NameLast NameDriver 10First NameLast NameDriver 11First NameLast NameDriver 12First NameLast NameDriver 13First NameLast NameDriver 14First NameLast NameDriver 15First NameLast NameDriver 16First NameLast NameDriver 17First NameLast NameDriver 18First NameLast NameDriver 19First NameLast NameDriver 20First NameLast NameCost CalculationP.O. # (Note: no cash or personal checks accepted)* For credit card payments please contact Kathy in our office at 419.222.1836 ext 213.Treasurer E-mail Address* Enter Email Confirm Email Pre-Service Drivers Registration Cost – $150 eachRe-certification Drivers Registration Cost – $100 eachTotal CostQuestions? Comments?Leave us your questions and/or comments and we will get back with you.