Alive at 25 Online Registration Form

Alive at 25 Online Registration Form

Use this form to register for Alive at 25 classes. Please fill out all fields, then click the submit button.

You may get more information about the Alive at 25 program here.

You may print out and mail a form here.

If you have any questions, please contact Jeff Williams at the Miami County Sheriff's Office. The number is 765-469-5209. Remember to leave a message with a call back number if you do not reach me, and I will return your call as soon as possible.

Driver's License Number
Email Address
Last Name
First Name
Middle Name
Mailing Address
City
State
Zip Code
Your Home Phone
Your Work Phone
Your Date of Birth
Sex
Eye Color
Hair Color
	What is your age group?
	Which best describes why you are here?
	Which date would you prefer?
	Please select an alternate date, in case
	your first choice is unavailable.
View the complete Alive at 25 2008 class schedule here.

Once you have completed the above enrollment form, click the 'Submit' button to send the information to us. You may use the 'Clear' button at any time to reset the form.