Enrollment Application Form printable pdf download

AARP Driver Safety Program Course sponsored by the West Hurley Public Library

Enrollment Application

The AARP Driver Safety Program is a total of eight (8) hours and is being offered in one session. You must attend

the entire session to be awarded a certificate. The course is taught by Andy Paradiso, a trained volunteer

instructor.

Date: Saturday, May 21

, 2016

Time: Sign in is at 8:30AM and the course runs from 9:00AM – ~5:30PM

Location:

West Hurley Firehouse, 24 Wall St, West Hurley, NY

Lunch: You will have a half hour for lunch, so please plan on bringing a bagged lunch. There is no air conditioning

AARP card and driver’s license for the

in the firehouse, so dress appropriately. Please bring a notepad, pen,

discount

Interpreter: You must bring your own interpreter. They will not receive a certificate unless they also register/pay

for the course.

Notes:

There is no age or membership requirement for the class.

The course fee is $20.00 for AARP members and $25.00 for non-members. Please enclose a check or money order

made payable to “AARP” with the bottom portion of this enrollment application. Do not send cash.

Enrollment

in the course is limited, so mail your application and payment to:

West Hurley Public Library

42 Clover Street

West Hurley, NY 12491.

Your application must be postmarked by Friday, May 16

if you are mailing it. For more information, call, (845)

679-6405.

Walk-ins will probably be accepted, but register to guarantee a seat.

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Please enroll:  Me or  Us in the AARP Driver Safety Program Course held on May 21st at the West Hurley

Firehouse.

Enclosed is a check or money order in the amount of

$_________________ made payable to “AARP”, which I understand is non-refundable.



I understand that the program takes place at the West Hurley Firehouse

Name(s):_______________________________________________________________________

Street Address: _______________________________________________________________________

City:____________________ State:_______________________ Zip Code:________________

Phone: ____________________________ E-Mail:_____________________________________

Total Payment: $_______________________________________________________________________

 I am interested in becoming a volunteer instructor at no cost to me.

Enrollment Application Form