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2017 Safe Teen Driving Registration
*
Tell us about your driving status
:
Choose:
Have Learner Permit
Have Drivers License
What is your age?
Choose:
16
17
18
*
Have you completed the MVA driving class?
Choose:
Yes
No
*
How far away are you from getting your license?
Choose:
1-3 months
3-6 months
6-9 months
*
Parent name:
*
Firstname
*
Lastname
*
Address:
*
City
County::
Prince George's County Only
Zip:
*
Phone:
*
Email:
*
How did you hear about the program?
Choose:
Radio
newspaper, article, or newsletter
Referral from a nonprofit
Web Search
Email link
Facebook
State Farm Agent
Referral from a foundation
Referral from a business
Referral from a friend
Conference, Training or Workshop
*
What would you like to share about your driving?
*
required field.