Defensive Drivers Ontario Enrollement Driving Course

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You only learn to drive once, do it right with Defensive Drivers Ontario

To enroll in our Defensive Driving Course, simply fill out the following form and submit it to us. We will process it the next business day and your name will be on file. Please leave us a telephone number where we may contact you during business hours if we require further information. Reservation is required for our regular program. Call for more information!

Personal Information

Last Name: *

First Name: *

Initial:

Street Address:

City:

Province:

Postal Code:

Phone:*

E-mail Address: *

How do you wish to be contacted?

Date of Birth: (mm-dd-yyyy)

Sex:

High School Attended:

Licence Information

Driver's Licence/Permit Number

Licence Class

Issue Date: (mm-dd-yyyy)

Expiry Date: (mm-dd-yyyy)

Other Information

Course

Course Start Date (mm-dd-yyyy)

How did you know about us?

Advertisement / Newspaper	Website	Search engine
Yellow pages	Family / Friend	Linked from another website
Neighbourhood / School	Others

Comments:

* Required to submit this form

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