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CHBC Van Drivers
This form should be filled out for any individual driving the CHBC 15 passenger van.
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* Indicates required question
Name
*
Your answer
Email
Your answer
Phone Number
*
Your answer
Driver's License Number
*
Your answer
Driver's License State
*
Your answer
Driver's License Expiration Date
*
MM
/
DD
/
YYYY
Driver's Car Insurance Provider
*
Your answer
On behalf of which entity are you driving the van?
*
Campus Outreach
9Marks
CHBC
Other:
Please watch the following video.
I have watched the safe driving video.
*
Choose
Yes
I have had a moving violation in the past three years. (If yes, you must be approved by the Associate Pastor for Administration before driving the van.)
*
Choose
Yes
No
Submit
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