Online Registration

Costs:

$25 per year

---

To renew your membership by mail, submitting this form and print the following page. Send a copy of the following page and your check or money order to safeteendriveronline.com at PO Box 22904, Eugene, OR 97402. Make sure to include your four digit sticker ID number on your check's memo. There will be a $50 charge for returned or NSF checks.

Renew Your Membership by Mail

Window Sticker ID Number:
(4 Digit Alpha Numeric Only. Examples: 0001, 0037, 1897) 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