How do I get started?

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To register your interest in participating in a IAM Roadwise training day, please complete the details below and click on the Submit button.

If preferred you can telephone on 07515 576923. After completion of this form you will then be sent a confirmation email. Once your course date is set you will be given a website link where you can make your payment.

If you reside in the Western Health & Social Services Board area, you can claim a 75% reduction in the £99 fee. Please indicate your confirmation by ticking the box on the form below. If you are unsure of the areas covered click here for details.

Plus, you could save up to 45% on your insurance!

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Fields marked with an asterisk (*) are mandatory.

First Name*

 

Surname*

 

Street 1*

 

Street 2

 

Town*

 

County*

 

Postcode*

 

Date of birth (dd/mm/yyyy)

 

Email*

 

Telephone (Daytime)*

 

Telephone (Evening)

 

Telephone (Mobile)

 

Date passed L Test (dd/mm/yyyy)

 

Have you any penalty points*

Yes
No

 

If YES please give details

 

Have you any illness or disability that would relate to this application?*

Yes
No

 

If YES please give details

 

I apply for the Western Health & Social Services Board subsidy. I confirm that I reside in the Western Health & Social Services Board area

 

WHSSB

Yes

 

How did you hear about IAM Roadwise? Please select AXA Other insurance company Poster advertising Local advertising Press advertising Driving test centre Western Health Other

 

If other please state

 

I confirm that to my knowledge, the information given in this application is true and complete. I understand that any false information could lead to the rejection of this application. If accepted, I undertake to be bound by the rules of the IAM Roadwise Scheme.*

 

Confirm

Yes