Iowa City – OCT. $400

Class Details

Saturday, October 31 - Sunday, November 15

Class Times

Oct. 31st.-Nov. 15th (10 days!)
Saturdays 8-11am & Sundays 5-8pm
Mon. & Thurs. 6:15-9:15pm
Drives completed by Nov. 15th

Class Location

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Class Registration Form

Spaces

Student First Name *

Student Last Name *

Student Middle Name

Student Preferred Name

Student Date of Birth (MM/DD/YYYY) *

Student Street Address *

City/Town *

State *

Zip Code *

Student DL No./Permit # (Not required)

Student Cell Number

Name of School *

Primary Email Address *

Parent Cell Number *

Parent First and Last Name *

Work or Home Number

Primary Doctor *

Primary Doctor Phone Number *

Preferred Hospital

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