Fill out this form to pay for a Behind the Wheel lesson (or blue slip registration) in Marshall. Student Full Legal Name (First, Middle, Last)* Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Home Address* Address 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 Email* Enter Email Confirm Email Phone*BTW Lesson Fee* BTW Marshall $115 Total $0.00 Credit Card* DiscoverMasterCardVisaSupported Credit Cards: Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20252026202720282029203020312032203320342035203620372038203920402041204220432044 Expiration Date Security Code Cardholder Name Parent Signature - I agree to the requirements listed below:* First Last PLEASE READ-- FAQ'S about Behind-The-Wheel Scheduling --PLEASE READ 1. We suggest at least 1 month (15 hours) of practice before the first lesson and between lessons. The first lesson must be scheduled within the first 4 months a student has held their permit (fee may apply.) You don't need to pay for the BTW lessons until you schedule them. 2. Each student will have three private, one on one lessons that are each two hours long. 3. YOU CAN ONLY SCHEDULE 1 LESSON AT A TIME. 4. DO NOT WAIT until the last minute to schedule the B-T-W lessons. Plan ahead for sports or other after school activities so the student will be able to take their road test as soon as they want to do so. Spring and Summer are the BUSIEST time for BTW. DO NOT WAIT until spring and summer to cram in all BTW lessons. 5. The only way a student will learn to be a safe driver is by driving. The law requires that parents must log a minimum of 50 hours of practice time with their child. 6. When a student has completed all three lessons, they will receive a "Completion Card." They will need to bring this "white slip" and their permit with them to the testing station in order to take their road test. It is best to make an appointment in advance for the road test to avoid waiting in long lines. 7. A student's contract with A+ EXPIRES two years from the date you complete this form. You do not need a Blue Slip if you are 18 or over. • THERE IS A $55 FEE ON ALL REFUNDS Δ
