Safe Driving Enrollment

Please fill in all appropriate fields so we may ensure proper enrollment. • PERSONAL INFORMATION • FIRST NAME: LAST NAME: DATE OF BIRTH: DRIVERS LICENSE NUMBER: • CITATION INFORMATION • CITATION NUMBER: ICR NUMBER: VIOLATION: DATE OF VIOLATION: • CONTACT INFORMATION • ADDRESS: CITY: STATE: ZIP: DAYTIME PHONE: EVENING PHONE: EMAIL: RE-ENTER YOUR EMAIL TO CONFIRM: Please enter the letters and numbers that appear above. This is to prevent spam.

Wabasha Police Department
900 Hiawatha Drive East
Wabasha, MN 55981
Ph 651-565-3261
Fax 651-565-5288
e-mail: police@wabasha.net