PTSD Awareness License Plate Pre-Commitment Form

Don’t wait—act now! Enter your information to get your distinctive Alabama PTSD Awareness license plate, which is free for the first year, courtesy of Sojourn Counseling. Each additional year you renew, $41.25 of your $50 tex-deductible renewal fee will go to provide free or discounted services for individuals living with PTSD.

If you want to receive more than one free license plate, please complete this form for EACH one.

Questions or want more information? Email Jennifer at jennifer@sojourncounseling.org

Email(Required)

Phone with the area code (no dashes or brackets)(Required)

Name(Required)

First Middle Last

(as it appears on your drivers license)

Do you want a license plate for personal or business?

Personal

Business

Address(Required)

Street Address Address Line 2 City State ZIP Code

Full mailing address, including CITY and ZIP CODE? Make sure this matches your personal address if you chose personal or your business address if you chose business. Businesses must use a physical address, not a P.O. Box.

What is the VIN of the Vehicle? (It's on your insurance card)(Required)

What is the Make of the Vehicle?

What is the Model of the Vehicle?

What is the Year of the Vehicle?

Would you like to personalize your plate? Your personalization will be handled at the DMV.

Yes

How did you hear about the PTSD Awareness License Plate?

What is your preferred method of contact?(Required)

Phone

Text

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