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:

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: 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!

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.