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2. First Name*
3. Last Name*
5. Phone Number*
6. Date of Birth
   Date of Birth
8. Email Address*
10. Did you receive a traffic ticket in Henderson County, Kentucky?*

    1. Yes
    2. No (not eligible for Henderson CATS Program)
12. Were you cited with any other charges other than a moving violation?*

    1. Yes
    2. No
14. Have you been through the Henderson CATS Program in the past? *

    1. Yes
    2. No
16. Do you have a commercial drivers license (CDL)? *

    1. Yes (Not eligible for Henderson CATS Program)
    2. No
18. Are you interested in the live program or the online program? *

    1. Live
    2. Online
20. Would you like to receive the documents in the mail or by email? *

    1. Regular Mail (will be sent to address listed on citation)
    2. Email
Leave This Blank:


22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

* indicates a required field