Ticket Dismissal – Pre Registration Form

Pre-Register for Ticket Dismissal Class:

• When you arrive for class, be sure to arrive 30 minutes early and remember to bring:
  • • Your driver’s license
    • The county, judge’s name, and city as listed on your citation
    • Cash, money order, Visa, MasterCard, or Debit Card for $30.00

  Note: You must come 30 minutes before first day of class to sign course agreement and make payment (cash, money order, Visa, MasterCard, or Debit Card)

  Choose - Class Date/Time *July 11 (9:00am - 3:00pm)July 25 (9:00am - 3:00pm)Aug 8 (9:00am - 3:00pm)Aug 22 (9:00am - 3:00pm)

  Driver's License Number and State Issued *

  Full Legal Name *

  First

  Middle

  Last

  Date of Birth (MM/DD/YYYY) *

  Sex: Male/Female *MaleFemale

  Phone Number (555-555-5555) *

  Address where certificate will be mailed to you *

  This does not have to be the same as the address as shown on your Driver's License. DO NOT USE THE COURT ADDRESS

  Court (as it appears on your citation) *

  NOTE: A CERTIFICATE FOR TICKET DISMISSAL WILL NOT BE ISSUED IF THE COURT INFORMATION IS NOT FILLED IN

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