Alive at 25 Print and Mail Registration Form

Use this form to register for Alive at 25 classes.  Please fill out all fields, then click the 'Print' button and mail the form to the address at the bottom of this page.  Please note that this form is currently configured to work with Internet Explorer and Fire Fox browsers only.

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

 

You may enroll online 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.

 

View the complete Alive at 25 2008 class schedule here.

 

Alive at 25 Enrollment Form
 
  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?

 

View the complete Alive at 25 2008 class schedule here.

 

Once you have completed the above enrollment form, click the 'Print' button and mail the form to us at:

 

 

Miami County Sheriff's Office

Alive at 25 Program
35 Court Street
Peru, IN 46970

 

You may also fax your completed form to 765-472-7520.

 

You may use the 'Clear' button at any time to reset the form.

 


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