Defensive Driving Class Registration:
Class Cost
Class Fee:
$ 95.00
Online Class Fee:
$ 30.00
Total Cost:
$ 125.00
Name:
First Name
*
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Last Name
*
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Address:
Street
*
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Street 2
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City
*
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State
*
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Zip Code
*
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Phone Numbers:
Home Phone
*
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Cell Phone
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Work Phone
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Contact Info:
Email
*
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Reason for Taking Course:
(Example: Court/Probation Referral, Reinstatement of License, Under 21 Point Accumulation,
2 Point Credit, or Other)
*
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Date of Birth:
(MM/DD/YYYY)
*
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Gender:
Male
Female
*
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Nebraska Safety Council 2023 : Lincoln, NE