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:



Zip Code:

Daytime Phone Number:

/ /

E-mail Address:

Driver License Number:

License State:


Male      Female

Date of Birth:

 /   / 

How Did You Hear about Us?

Promotional Code (Optional):

   What's this?