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Payment and Registration

Office or by phone credit card, debit card, and certified checks.

16200 Euclid Ave. suite 205

East Cleveland, Ohio 44112

cell: (440) 654-6290

office: (216) 785-9673

New Location !!!

Doubletree-Hilton Hotel-Cleveland

6200 Quarry Lane

Independence Ohio 44131

(216) 447-1300 

Name:                               Date:

Address:                               Case#                              

City:                               State:          Zip Code:          

Phone#:(   )    -        Alternative Phone#: (   )      -        

BAC:               Any Prior Substance Abuse Driving Offenses ?

As a condition of obligation to the court you are directed to attend and comply with the Pleasant People's Inc. Driver's Intervention Program. Your failure to attend or comply with the rules of the program could result in further action by the court.                                          

Date to attend:

Judge:                               Court:                           

Probation Officer:

Phone#: (   )        -               Alternative Phone#:(   )       -     

I authorize the above name court to release information contained on the sheet to the Pleasant People's Inc. Driver's Intervention Program.

I also understand the reports of my attendance and meeting other conditions of this assignment will be forwarded to the referring court.