Host A Class Please fill out the form below and someone from our office will contact you as soon as possible. NameThis field is for validation purposes and should be left unchanged.Contact Person(Required) First Last Contact Phone Number(Required)Contact Email(Required) Facility InformationDo you have a location available?(Required)Select YES or NOYESNOLocation NameLocation Address Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How Many People Will Your Facility Hold?10-2021-3536+Please let us know possible date(s) and time that you would like to host a class. Date MM slash DD slash YYYY Date MM slash DD slash YYYY Date MM slash DD slash YYYY Start Time Hours : Minutes AM PM AM/PM Classes are in 4 hour increments. Instructor will need approx. 20 min before and 20 min after for set up and tear down. Additional Comments or QuestionsThere is no cost to you to host the class. We will send you posters and flyers to help promote the class, please feel free to add details to any social media or advertising you have at your disposal. Seniors For Safe Driving will be responsible for all registrations unless you would prefer to handle. Any media devices available are appreciated but not required. Our instructors are fully equipped. Light refreshments are suggested but not required. Seniors For Safe Driving will need a minimum of 4 hours to present the class. At the end of the class everyone gets a certificate that they will then provide to their insurance agent to receive their discount.CAPTCHA
