Education Resource of Texas Pre-Registration Form


Education Resource of Texas

DWI, DOEP, MIP, MoM & PI classes in Austin, Tx · Ph: 512-786-3673

*Some classes are
offered in Spanish

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Pre-Registration Form for

MIP Alcohol Education for Minors Course

Pre-Registration allows us to better anticipate class size and to notify you in the
unlikely event of changes to the class schedule.

Required fields are marked with an asterisk.

*Your Name:

*Address:

*City:

*State:

*Zip:

*Daytime Phone:

*Evening Phone:

*Email Address:

Question/Comment:
(if any)

MIP Class Schedules — Austin Texas
The MIP Course is comprised of TWO 3-hour classes:
(Advance payment is not required for pre-regristration.)
Please select the Class Schedule that you'd like to attend from the list below:

	Saturday, September 18, 2010 9:00 am to 12:30 pm	and	Sunday, September 19, 2010 9:00 am to 12:00 pm

	Saturday, October 2, 2010 9:00 am to 12:30 pm	and	Sunday, October 3, 2010 9:00 am to 12:00 pm