DRIVEINCONTROL Email Marketing -

Interest in Crash Prevention 101 training sponsored by Burlington Police!

By completing this form you are letting us know that you would like to take advantage of the free Crash Prevention 101 training from In Control, thanks to the Burlington Police Department. You must be a resident of Burlington and have a drivers license or learner's permit (with at least 8 hrs of driving with parent/drivers ed).

Once submitted we will email or call you if seats become available. You must be available to train within a few weeks of confirmation (dates are typically Sat/Sun and some weekdays).

First Name*

Last Name*

Email*

Phone*

Street Address*

Home Zip Code*

Participant Date of Birth*

Driver's License/Permit Type*

Learner's Permit (less than 8 hrs driving)

Learner's Permit (more than 8 hrs driving)

Junior Operators License (age under 18)

Typical Drivers License

Commercial Drivers License

License Revoked

No License

Message

Please verify your request.*