Online Registration

Costs:

$25 per year
$10 one time sticker set up fee

---

To pay using PayPal, please fill out all of the fields below. Print the next page for your records, then continue to Paypal's checkout web page.

Part 1 of 2: Your information

Parent/Guardian Name:
Mailing Address:
City:
State:
Zip Code:
Phone:
Email Address:
Confirm email address:

Note: Reports will be sent to this email address so make sure it remains active. Please contact us if your email address changes in the future.

Name of Teen Driver:
Age of teen driver:

---

Description of vehicle the sticker will be placed on: Make:
Model:
Year:
License Plate Number:
State:

---

Only $25 per year with a one time sticker set up fee of $10
Helping Parents Keep Teen Drivers Safe.

To submit this form, please enter the characters you see in the image:

PLEASE DOUBLE CHECK YOUR INFORMATION BEFORE CLICKING SUBMIT