State Advanced Class Registration Form – 2024 District/Driver InformationSchool District/Employer* Choose your PreService Instructor*Brandon AnnessJoe DietrichLori FangerRob HiggenbothamBill EllisEvette MoodyMarvin PenningtonJim SullivanBilling 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* E-mail Address Confirm E-mail Address Location*June 17-18, Logan High SchoolNumber of Drivers Attending*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)* Treasurer E-mail Address* Treasurer E-mail Address Confirm Treasurer E-mail Address Total Cost – $100 eachQuestions? Comments?Leave us your questions and/or comments and we will get back with you.