Class Registration

Are you signing up for DUI Victim's Impact Panel, Alcohol & Drug Information School, or the all-day combination of both?(please enter VP, ADIS or Both)
First Name: *

Last Name: *
Your Birthdate (mm/dd/year) *

E-mail Address:

Class Date (mm/dd/year) *
Alternate Telephone:

Location (Indicated Bellevue, Kent or Everett) *

Your Assigned Case # (if applicable)
How Did You Hear About Us?

* Indicates required fields

Please come appropriately dressed and sober.  We reserve the right to refuse service to anyone under the influence of drugs or alcohol, regardless of whether they are legal for your personal use.   Attire which promotes, celebrates or advocates the use of drugs and alcohol is inappropriate.  You may be asked to reschedule your class if your attire, behavior or ability to participate in the class is deemed disruptive or inappropriate.