**IMPORTANT: Please be sure to have your case, citation or docket number and court information handy before you begin your registration. You will need to complete this registration page within 20 minutes to avoid an error.**
 

Please complete the following form.
When you are finished, click on the submit button.
NOTE: Please use capitalization AS YOU WOULD LIKE IT
TO APPEAR ON YOUR COMPLETION CERTIFICATE!
* Are Required Fields.
Use the TAB key to advance, Do NOT hit the Enter key.
* If you are doing the program for an Insurance Company Discount
Your DRIVERS LICENSE number will be your CASE NUMBER.
(citation or docket number)
Case Number : * Please OMIT all SPACES or DASHES!
Retype Case Number : *
(choose a password to enter the Activity area)
Password : *
Retype Password : *
First Name : *
Last Name : *
Street Address:
Your street address will be asked as a security question! *
 
Address 2:  
City : *
State : *    Zip   *
Driver's License Number:
Your driver's license will be asked as a security question! *
 
Phone :
Your phone number will be asked as a security question!*
E-mail Address :   
(If you do not fill out a valid E-mail address, you will NOT receive a confirmation when we fax your certificate into the court!) 
We absolutely DO NOT sell or share e-mail addresses or student information with 3rd parties. This is our primary means of contacting you regarding your program or completion.
 
 
Court Assigned Due Date :
Your court due date will be asked as a security question!*		  /  /  This WILL be printed on all paper completion certificates.
Please follow this format :    mm  / dd    / yyyy
* Please Choose the Approved Court Name Below!
Your approved court will be asked as a security question!
$13.50 - Internet Program
$19.95 - PDF Workbook Program

 Please DOUBLE CHECK after you choose to be sure the correct
court name is displayed!
FINAL 5 SECURITY QUESTIONS:
IMPORTANT!! As an identity security measure,
you will be asked the following questions AND the 5 security questions indicated above
throughout your program. You will need to enter the information EXACTLY as you entered it below
when the questions arise, or your program will become inaccessible.
THESE ENTRIES ARE CASE-SENSITIVE!
 
What is your mother's FIRST name? (NOT her Maiden name) : *
(We recommend using all capital letters.)
How many pounds do you weigh?: *
What COLOR was the car you were driving when you received your ticket?: *
(We recommend using all capital letters. Please put in only ONE word.)
Date of Birth : *  /  / 
Please follow this format :
(Please put in a 0 if there is no number. EX: 09/02/1960
DO NOT PUT 2011 FOR THE YEAR!)   		 mm/dd/yyyy
What year does your driver's license expire? : *
Please follow this format :     yyyy

PLEASE CHECK YOUR ENTRIES TO YOUR 
SECURITY QUESTIONS BEFORE YOU CONTINUE!
Access to your program will NOT BE POSSIBLE if the answers are not typed 
EXACTLY the same when the security questions appear!
  

©Copyright 1998-2011 InterActive Traffic School M. Pearl

All Rights Reserved