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Segment One

$499

24 hours of classroom instruction and 6 hours driving

Students First Name*

Students Middle Name*

Students Last Name*

Students Birthday*

Month

Day

Year

Phone Number*

Email Address*

Multi-line address

Country/Region*

Address*

City*

Zip / Postal code*

Class Location*

734-665-3810

champion@championdrivingschool.us

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