(715)570-9909
www.lifeontheroadllc.com
chuck@lifeontheroadllc.com

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Class Registration Form


		1) Enter your ZIP Code. (Required)
		2) Enter Your Street Address. (Required)
		3) Enter your appt/suite Number if any.
		4) Enter your phone number. (Required)
		5) Enter your first name. (Required)
		6) Enter your middle name. If you have one.
		7) Enter your last name. (Required)
		8) Enter your date of birth (MM/DD/YYYY). (Required)
		9) Enter your parent name. (Required)
		10) Enter your parent phone number (Required)
		11) Enter YOUR VALID email address. (Required)
		12) Enter YOUR PARENT VALID email address. (Required)
		13) Choose your high school. (Required)
		14) Choose any driving restrictions you may have. (Required)
		15) Choose your class (Required)

		16) By checking the checkbox and typing your name in the field left of the checkbox you are "signing" the agreement.
		17) Click Submit

		18) Scroll down and check your information, you may save the contract as a PDF below if the green text under the SUBMIT button is "SUBMITOK" You may also pay by credit card below.

Pay By Credit Card