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Office use only: Date Received_________ Receipt # _________ Amount _________ Session _________                                              
 Return  form, $75.00 deposit or $385 if paid in full to: Drivers2B 644 Hillcrest Dr. Waupaca, WI 54981 or call  (715) 258-7887
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Students Full Legal Name

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Students Month, Date, Year of birth                                                Telephone Number including area code

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Students Address, City, State, Zip Code

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Parents Signature

Check one ______Deposit Only  _____Entire Course

Check course desired: _____Classroom and BTW   _____ Classroom    _____ BTW    _____ Refresher Course
2011 Dates
_____SEPTEMBER 12 - SEPTEMBER 30 WAUPACA
_____OCTOBER 3 - OCTOBER 21 IOLA-SCANDINAVIA
_____OCTOBER 24 - NOVEMBER 11 AMHERST 
_____OCTOBER 24 - NOVEMBER 11  WAUPACA
_____NOVEMBER 28 - DECEMBER 16 WAUPACA 
2012 Dates
_____JANUARY 9 -  JANUARY 27 WAUPACA
_____JANUARY 30 - FEBRUARY 17  WAUPACA
_____FEBRUARY 27 -  MARCH 16 AMHERST
_____FEBRUARY 27 -  MARCH 16 WAUPACA
_____APRIL 9  - APRIL 27 WAUPACA
_____MAY 7 -  MAY 25 IOLA
_____JUNE 4 - JUNE 22  WAUPACA
_____JUNE 11 -  JUNE 29  8 am-10 am WAUPACA
_____JULY 9 -  JULY 27 WAUPACA
_____AUGUST 6  - AUGUST 24 WAUPACA
_____SEPTEMBER 10 -  SEPTEMBER 28 WAUPACA
_____OCTOBER 1 -  OCTOBER 19 IOLA
_____OCTOBER 29 -  NOVEMBER 16 AMHERST
_____OCTOBER 29 -  NOVEMBER 16 WAUPACA
____NOVEMBER 26 -  DECEMBER 14 WAUPACA
Please note all classes run from 6-8 p.m. Monday through Friday throughout the session.
Minimum of 15 students for class to be held so bring a friend.