Michigan Basic Driver Improvement Course Registration

Please fill out this form completely and then click the "Continue" button. Your login code will be sent to the e-mail address you provide.

First Name:

Middle Initial:

Last Name:

Current Mailing Address:

City:

State:

Zip Code:

Daytime Phone Number:

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E-mail Address:

Driver License Number:

License State:

Gender:

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Date of Birth:

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Course Completion Deadline:

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