Last Name *

First Name *

Middle Name

Home Address

City

Province

Postal Code

Student Home Number Example: 123-456-7890

Student Cell Number Example: 123-456-7890 *

Email Address

Date of Birth (MM/DD/YYYY)

Gender *

Student Class 7 License #:

Condition Code- Choose From the list

Issue Date (MM/DD/YYYY)

Expiry Date (MM/DD/YYYY)

Name of Parent/Guardian

Parent/Guardian Cell Number Example: 123-456-7890

Driving Experience (if any, in months)

All Prices excluding GST*

Additional Comments

BY CLICKING CONTINUE OR SUBMIT THE PARENT/GUARDIAN/STUDENT'S NAME ACTS AS THE SIGNATURE

*Please note all information on the registration form will be kept confidential and will be disclosed only to Alberta Transportation

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