Fillable RMV - Community Outreach Workshop Request Form

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RMV - Community Outreach Workshop Request Form

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Community Outreach
Workshop Request Form
P.O. Box 55889 Boston, MA 02205-5889
MAB120_0618
The Registry of Motor Vehicles (RMV) offers free workshops on issues facing older drivers, their families, and caregivers:
1) Shifting Gears – rules of the road, defensive driving, and safe driving tips;
2) The Driving Decision – Advice for families and providers who are concerned about a person’s ability to driv
e
s
afely;
3) Disability Placards and Plates – information on how to obtain a placard or plate and the laws governing them
4) Real ID – Information on new federal and state requirements concerning driver’s license and ID card renewals.
To request a program, please complete the entire form and mail or email it to:
Michele Ellicks
Community Outreach Coordinator
Registry of Motor Vehicles
P.O. Box 55889 Boston, MA 02205-5889
Phone: 857-368-9457
Email: Michele.Ellicks@state.ma.us
A. Contact Information
Name of Organization
Address
Contact Name
Contact Email
Contact Phone #
B. Workshop Request
Workshop Requested:
Workshop 1
Workshop 2
Workshop 3
Real ID Workshop
Please suggest 3 dates and times:
1. First choice:
2. Second choice:
3. Third choice:
The approximate number of people attending this presentation: _______
The site for this presentation is:
Room
Auditorium
You will be contacted by the RMV for confirmation of the date indicated.
Time
:
Time:
Time:
Date:
Date:
Date:
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RMV - Community Outreach Workshop Request Form

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Completed 11 May 2020

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