Black Car Safety Center

Signup for the 4 Hour Wellness Class


Step 2 - Complete all the information below and click on the "Submit Request" button at the end of the form. 

Date:

Class Requested:

First Name:
Last Name:
Social Security Number
 - -  Date of Birth: mm/dd/yyyy

Address:
NOTE Please enter the address of your current residence. This is the address your check will be mailed to.

City:

 State: Zip:

Cell Number:

DL Number:

TLC Number:

NOTE Please select your company base from the list.

Company Base:

Email Address:

As an IDG and Black Car Fund member, you can be automatically enrolled in Drivers Benefits so that you can start using the benefits available to you as a New York Black Car driver. IDG and The Black Car Fund have worked hard to provide you with benefits including telemedicine (free access to a doctor 24/7), prescription discount cards, affordable legal service, and others.
Would you like to be enrolled in Drivers Benefits for free? Yes, enroll me in Drivers Benefits so I can start using my free benefits.

No, I do not want to use my free benefits right now.

 

Your request may take a few seconds to process - Do Not press the "Submit Request" Button twice!