Defensive Driving Online Course Registration Defensive Driving Online Registration Form TDLR Approved Defensive Driving Online Registration Form Please use this form to register for our online courses - you will be emailed a confirmation of registration to the email you provide.Your Name(Required)Students First Middle and Last Name First Middle Last Your Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code 123 Main Suite #, P.O Box Etc.Drivers License #(Required) 12345678Drivers License State Issued(Required)AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificPhone Number(Required)000-000-0000Date of Birth(Required) MM/DD/YYYYSexMaleFemaleOtherEmail Address(Required) Enter Email Confirm Email you@domian.comPassword(Required) Create Your PasswordProcessing Options(Required) Mailed Certificate - $25 Course Fee (processed and mailed within 7 days) Instant Certificate Download - $25 Course Fee +$10 (Available Instantly upon completion) Payment Type(Required)Credit CardContinue Now, Create Account and Pay Later