Local Class Registration Form 2022-2023 District/Driver InformationSchool District/Employer* Billing Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest 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 Class Attending, MUST ATTEND FIRST DAY OF CLASS!*July 11-14 @ PentaJuly 18-21 @ Van BurenJuly 25-28 @ ArchboldAugust 8-11 @ TiffinAugust 22-25 @ LimaAugust 29-Sept 1 @ Bowling GreenSeptember 12-15 @ Lincolnview 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* Treasurer E-mail Address Confirm Treasurer E-mail Address Pre-Service Drivers Registration Cost - $85 eachRe-certification Drivers Registration Cost - $60 eachTotal CostQuestions? Comments?Leave us your questions and/or comments and we will get back with you.