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: Location: 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: NY NJ CT PA Zip: Cell Number: DL Number: TLC Number: NOTE Please select your company base from the list. Company Base: 12th Street Luxury Cars, Inc. 28 Express Inc. 2s Luxury Inc. 5 Golden Carriage Limousine, Inc. 510 Black Car Corp. 7 Ways Transportation Corp. 786 Transportation Rides, Inc. 811 Transit Corp. A List Luxury Services LLC (dba Lea A&$ Limousine Service Corp. A&J Car Service Corp. A&S Limousine Service Corp. A&Z II Limousine Transportation A&Z II Luxury Limousine Transportat A&Z Luxury Limousine Transportation A1 Accessible Transportation LLC AAA Family Limousine Service, Inc. ABA Luxury Car, Inc. Abel Black Car Inc. Abi Group Luxury Inc. Abian Transportation Inc. Abiel Transportation Corp. Absolute Car Service Corp. Ace Car & Limousine Service, Inc. Acht-NY, LLC(Uber) Achtzehn-NY,LLC(Uber) ACK Transportation Corp. Adara NEMT Corp. Admire LLP. Advance Luxury Limo Svc Inc. Agape Luxury Corp. Agora Car Service Inc. Aguila Car & Limo Corporation. Alcon Express Inc. Alianza Transportation Service Inc. All City Corporate Transportation, Allstate Private Car & Limo. Alpha Express Ride Corp. Alphine Limousine Service, Inc. Ambar Transportation, Inc. American Limousine LLC. Amerikanisch Services Corp. Amino, Inc. (dba Chris Limousine U. Ann's Car & Limousine Service Anytime Forsyth Transport Corp. AP Luxury Limousine Inc. Apex Car & Limo Service, Inc. Approach Quality Transportation LLC Aristacar & Limousine Ltd. Armony Transportation Inc. ASAP Luxe Inc. Asher Transportation Inc. Asiana Limousine, Inc. Atlantis Transportation Services In Atlas Travel & Limousine Inc. Aureus LLC. Auto Group Inc. Automotive Service Systems, Inc. Avalon Corporate Car, Inc. Avenue O Car Service. Axum Corp. d/b/a Central Park Limou Balayira LLC. Baronas Luxury II Inc. Bayridge Express Luxury Inc. Bee Bee Luxury Service Inc. Bell LX, Inc. Bell Radio, Inc. Bens Luxury Car & Limousine Service Best Deal Black Inc. Big Apple Car, Inc. Big O Limo Corp. Black Car Express.com Corp Blackbird Worldwide Corp. Blade Urban Ground Mobility Blessing Transportation Group, Inc. Blue Eagle Transportation Service C BQN Voucher Inc., Brisk Car Service Inc. Brooklyn Ride Corp. Buffalo Taxi Services, Inc. Buraq-NY, LLC BWJ Group Inc. C&A Black Car, Corp. Cabot Limo NY Corp. Cairo Transportation Inc. Caprice Car Service Corp. Caprice Car Service No. 2, Inc. Car Line Transportation Corp. Carey Limousine NY, Inc. Carey Limousine Stamford, Inc. Carlux Limo Inc. Castillo Car & Limo Inc. Cavalier Car and Limousine, Inc. Celebrity Luxury Inc. CEO Chaffeured Services Corp. CET Group, Inc. Cha Cha Transportation Corp. Charge & Ride Luxury, Inc. Charge & Ride, Inc. Charlie Black Car Inc. Chauffeured Executive Transportatio Cherry Transportation NY Inc. Chico Express Service Corp. China Transit, LLC. Choice Transportation Corp. Chris Limousine U.S.A. Inc. Cibao 2 Inc. City WAV Corp. CJ Limousine LLC Clay Transportation Inc. CMS Limo, Inc. Commack Trawell Inc. Commonwealth Worldwide Chauffeured Communicar, Inc. Compass Transportation Group Worldw Concord Limousine, Inc. Continental Ride, Inc. d/b/a I & I Convenience Ride Transportation Ser Cool Way Technology, Inc. Coop Car Care Inc. Corporate Car Ltd. Cozy Ride Limousine, Inc. Crestwood Car & Limousine Services, CSL Manhattitude Executive Transpor CTG Logistics, Inc Curb Transportation Services, LLC DAG Network Transportation Dahlia Transportation Corp. Danach-NY, LLC.(Uber) DAT Transportation Inc. DD & Son, LLC B00448 Dial Car, Inc. Diane Car Service, Inc. Discover Limo, Inc. d/b/a Infinity Divine Luxury Transportation Inc. DLS Transportation Corp. Dreist-NY, LLC(Uber) Dreizehn-NY, LLC(Uber) Drinnen-NY, LLC(Uber) Dunamis Care Car Service Corp. DV Luxury Transportation Corp. E Cars & Limo Service, Inc. Eagle Towncar & Limousine Service Eastland Black Cars Corp. Eckford Lite Car & Limo Inc. EDL Transportation Services LLC Eins-NY, LLC(Uber) Einundzwanzig-NY,LLC(Uber) Elf-NY, LLC(Uber) Elite Coach Inc. Elite Limousine Plus, Inc. Empire International, Ltd. (dba Emp Endor Car & Driver, LLC Entransit, LLC Epic Car Service Inc. Equaltrans LLC Ernest Schwarz, Inc. Europe Limo Svc Inc d/b/a Blink Lim Europe Limousine Service Inc. Every Where Limo Service, Inc. Excelsior Car & Limo. ExecTransport, Inc. Executive Town Car & Limo Corp. Exit Luxury Inc. Expert Care Transportation, Inc. (d Explorer Express Inc. Extra Car Service LLC EzCar.com LLC d/b/a Easy Car Face Limo, Inc. Fanny Radio Dispatch Service Inc. Fatsride Limo Inc. FC Limousine Inc. Fenix XL Car and Limo Service Corp. Finesse Group Limousine, Inc. First Class Luxury Inc. First Class of New York Inc. Five Star Luxury Flatiron Transit, LLC(Via) Fleet Radio Dispatch Corporation d/ Flex Express Corp. Flushing Limousine Transportation S Flyte Line Transportation, LLC Fone-A-Car, Inc. For All Seasons Limousine Network, Forever Blue Car Service Funf-NY, LLC(Uber) Funfzehn-NY, LLC(Uber) G&J Luxury Transportation, Inc. Gallant Luxury Service Corp. Ganix Transportation Inc Genesis Luxury Transportation Corp. Gewesen Transportation Corp. Gigi NYC Inc. Glide Luxury Transportation, Inc Global Executive Limousine Corp. Global Limousine Service Go My Sedan LLC Good Day Transportation Inc. Good Friends Car Service Inc. Grafe Street Service Corp. Grand Transportation Services Inc Gravitas Primo, LLC Greenlight Transportation Service L Greenpoint Transit LLC GroundAnywhere, LLC. Groundlink Holdings, LLC d/b/a Grou Group Americar Grun, LLC. GSL Limousines Corporation Guadalupana II Car & Limo, Inc. Guest Travel Service Inc. Guillen Transportation Services Inc Gulf Luxury Inc. Gypsy Transportation Corp. Harrison Car Service Inc. Health Black Car Services, Corp Heisenberg-Esser Corp. Hermany Limo Transportation, LLC HH Car Service Inc. Hinter, LLC.(Uber) Holy Transportation Corp. Hudson Heights Transportation Inc. Hybrid Limo Express, Inc. Hytch Holding LLC ICS-NY, Inc. Iffy Towncar Service, Inc. d/b/a Ro Inspiration Group Inc. Inta-Boro Acres, Inc. Interstate Luxury Limousines Inc. Iwagami Limousine, Inc. Jarocho Car Service Inc. Jarpa Transportation Corp. JBK New York Inc. d/b/a Comfort Lim JC and M, Inc. JC Luxury Inc. JD Xpress Inc. Jetset Transportation Corp. JFK Luxury Limo, Inc. Joy Luxury, Inc. Juniors Luxury Inc. Jupiter Select LLC. Just a Moment Car Service Inc. Kaluma Transportation Group Inc. Kayl Inc. Kid Car NY, LLC. Kidault Kar LLC. Kidmoto Technologies LLC Kirin Transportation, Inc. Kismet International, Inc. Kiss Luxury Transportation Inc. Kyoei Limousine, Inc. L&J Logistics, Corp. La Mexicana Express 2 Inc. Lanas Limo, Inc. Last Radio Group Latino Executive Inc. Legend Luxury Limo Inc. Legend Luxury Limo Inc. Leopard Inc. Level Limo, Inc. LFS Limo Corp. Li Yang Limousine, Inc. Liberty Communications, Inc. Liberty International Trading, LLC. Liberty Medicar Inc. Limo 360 Inc. Limo Seven Transportation, Inc. Limo Tribe Inc. Long Island City Car & Limo Inc. Los Paisanos Luxury Car Service, In Love Corporate Car, Inc. Love Limousine NYC Ltd. Low Touch Luxury Inc. Luxe Riders Corp Luxoride Inc. Luxury Worldwide Transportation, LL Luxus Limo LLC. Lyft Healthcare,Inc. Lyft, Inc.(non NYC TLC) M.L. Trips Corp. Macombs Transportation Corp. Malibu Car Service Inc. Mama Mia Transportation Corporation Manga Transportation Corp. Manhattan International Limousine N Marathon Car &Limousine Service, In Mariachi Car Service Inc. Marr Limo LLC Matthews Limo Inc. Mavrik Trans, Inc. Mavros Transportation Inc. Maxi Luxury Cars Corp Mazna Transportation Corporation. MBS Limos LTD MDM Transportation Corp. Medrock Car Service, Inc. Meem Services Inc. MGL Transportation01, Inc. Mikes VIP Transportation, Inc. Milky Way Limo Corp. Mineola Transportation, Inc Mirage Limousine Service Inc. Mizuma International, Inc. MJ Luxury Inc. MLL Limousine Services, Inc. Murray Express Car Service Inc. Murrays Limousine Service, Inc. My Sedan LLC Myle Worldwide Inc N.Y Car & Limo Services Inc N.Y. One Corporate Car Inc. Navi Transportation Inc. NBT Transportation Inc. ND Line Inc. Necropolis Trans Corp. Nesh Limousine Service LLC (dba NLS Neun-NY, LLC(Uber) Neunzehn-NY, LLC(Uber) New Apple Trans Inc New Bell Luxury Corp New Black Luxury Cars Corp New Bushwick Luxury Inc. New Century Car Service Corp New Generation Black Car Transporta New Heaven Luxury Inc New Technology Transportation Inc New York Apple V.I.P. Corp Newport Corporate Car Neza Express Inc. Northside BK LLC. Norwood Car & Limo Inc. Norwood Transportation Inc. NY Merengue Transportation Inc. NYBC Luxury Limousine LLC NYC 2 Way International Ltd. NYDKB Inc. NYM Express Inc. Odyssey Transportation, LLC. On Line Limousine LLC. Onboard Transportation Inc. One Stop Ride LLC. Onix Transportation Inc. Onyx 1 Inc. OP Car Service Inc. Optimum Car & Limo Inc. Orion Luxury Corp. Oscar Limousine Inc. OSO Auto Corp Ottoman Transportation Inc. Paisa Classic Black Inc. Parada Luxury Inc. Paramount Transport Inc. Park West Executive Services d/b/a Town Car Paseo Transportation Inc. Paxxia Luxury Corp PCS Limousine Inc Peter Executive Limousine Corp. Phase One Transport Inc. Pibe Transportation Inc. Planet Limousine, LLC. Platinum Car Corporation Plush Services, Corp. Polo Limousine, Corp. Popular Transportation Corp. Port Richmond Black Car Inc. Preferred Care Transportation Service Inc. Prime Time Transportation Inc. Priscilla Black Car Inc. Prospect Luxury Car Service Puebla Luxury Corp. Puerto Rico Express Black Luxury Inc. Q Family Digital Dispatch Corp. Q-First Limousine Corp. Quality Executive Limousine, LLC. Quest International Limousine Inc. Quick and Luxurious Black Car Corp Quiet Services Inc. Raiser-NY, LLC.(Uber)(non NYC-TLC) Reagan Conveyance Corp. (dba Delux Transporta ResQ Ride Corp. Reyno Inc. Ricky Limousine Services Inc. Ride FHV Corp. Ride Smart Corp. Ride Solution Worlwide Inc. Ridgeway Transit Inc. Rincon Transportation LLC Rise and Shine Transportation Inc. Ritzy Transportation Corp. Riverside Classic Inc. Road New York Enterprises Inc. Roosevelt Car & Limo Inc. Royal Dispatch Services Inc. d/b/a Executive Royalty Family Corp. Sabo One, LLC(Gett) Sabo Two, LLC(Gett) Safe Rides Car & Limo Services Inc. Salam Car Service Inc. Sano Car, LLC Sarinas Limo & Car Service Inc. Saros Transportation Group Inc. Scarsdale Veterans Car & Limousine Service, L Schmecken, LLC.(Uber) Scorpio Five Star Car & Limo Service Inc. SDR Transportation Corp. Seagull Ride Corp Sechs-NY, LLC(Uber) Sechzen-NY, LLC(Uber) Sedwick Transportation Corp. Select Trans Inc. SempeRide LLC Showtime Transportation, Corp. Sieben-NY,LLC(Uber) Siebzehn-NY,LLC(Uber) Simple Cars LLC Sisko Transportation Inc. Skyline Credit Ride Inc. SpotOn.Pet LLC SS Limousine Service Inc. Standard Limousine & Car Service Group, LLC. Staten Island Transportation Services Inc. Stride Transportation Inc. STS Luxury Inc. Summit Corporate Car Inc. Sunny Day Transportation, Corp. (dba Sun Ligh Sunnys Limousine Service Inc. Super Fast Limousine Service Inc. Supraride Inc. Take Me 2 Inc. Tap & Ride Inc. Tel-A-Car of NY, LLC. Tempo Transportation Corp. The Best We Can Transportation Inc. The Original Dial Car & Limo Inc. Times Transportation Inc. Torinko NY, LLC Tracy Luxury Corp. Trans City Transportation Inc. Transmedi, LLC Traxline Car Service Inc. Tri-City, LLC(Lyft) Tri-County Black Cars Inc. Tri-State Ground Transportation, LLC. Turing Enterprises Inc. TWR Car & Limo Inc. U1st Transportation Services LLC. Ultra Black Car Transportation Corp. Unicar Luxury Inc. Unter, LLC. US Limo System Inc. USA Drivers Group Inc. USA Limo Inc. UTOG 2-Way Radio Inc. V & C Inc. V R Worldwide Inc. V.I.P. Connection Inc. d/b/a Car Link V.I.T. Black Car Transporation Vahana Inc. Valera Global Inc. Vier-NY, LLC(Uber) Vierzehn-NY, LLC(Uber) Ville De La Liberte Chauffeur Inc., Vital Platinum Services Inc. Vital Transportation Inc. VJVM Car Service Inc. W Diamond Limo Inc. W.K. Express Limo Service Inc. WC Transportation Service Group Inc. Weiter, LLC.(Uber) Westchester Acquisition Corporation d/b/a Fly WMC Service Inc Woodhaven Limousine Inc. Wow Services Inc. WST Limousine LLC X Y Z Two Way Radio Service Inc. XYZ Limousine Inc. Yerz Car Inc. YUR Drivers Network Inc. Zehn-NY, LLC(Uber) Zip Connections Zwanzig-NY,LLC(Uber) Zwei-NY, LLC(Uber) Zwolf-NY,LLC(Uber) ZYT Express Corp. 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! Facts You Should Know As you may know, the Black Car Fund provides drivers in the black car industry with workers’ compensation benefits. In order to help its covered drivers stay healthy and reduce accidents that lead to injuries the Black Car Fund is sponsoring this Program for the purposes of injury and medical claims reduction. The Program is provided to you as a driver covered by the Black Car Fund and is not intended to provide you with any rights of employment or to otherwise affect your status as an independent contractor with respect to the Black Car Fund or with the dispatch base you are affiliated with. While we hope you will participate in the Program, the Program is entirely voluntary and you are not required to participate. If you are an employee driver, this Program is not sponsored or endorsed by your employer. The Program is not intended to be covered by the Employee Retirement Income Security Act (ERISA) or the Patient Protection and Affordable Care Act (“PPACA”). If you register for the telemedicine benefits available under the Program, you may become ineligible to contribute to a health savings account. Consult with your tax advisor for more information. The Black Car Fund reserves the right to revise or terminate this Program in whole or in part at any time, and for any reason.