Mail Order Registration

Costs:

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

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This registration must be completed and mailed with your check or money order to safeteendriveronline.com at PO Box 22904, Eugene, OR 97402. There will be a $50 charge for returned or NSF checks. After submitting this form, please print the following page and submit it with your payment.

Sign Up by Mail

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:

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

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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