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Enrollment

Membership Desired

Drive America Select Individual Plan (9_95)

$9.95/month

$115.00/year

Drive America Select Family Plan (11_95)

$11.95/month

$140.00/year

Repair Assist w/12 Month Maintenance (39_99)

$39.99/month

$475.00/year

Repair Assist w/12 Month Maintenance (49_99)

$49.99/month

$575.00/year

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personal information

First Name*

MI

Last Name*

Email Address*

Street Address*

Apt/Unit

City*

State*

ZIP Code*

Cell Phone*

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Dependents

Spouse First Name

MI

Last Name

Eligible Children

Child's First Name

MI

Last Name

Child's First Name

MI

Last Name

Child's First Name

MI

Last Name

Child's First Name

MI

Last Name

Child's First Name

MI

Last Name

Child's First Name

MI

Last Name

Child's First Name

MI

Last Name

Child's First Name

MI

Last Name

Child's First Name

MI

Last Name

Child's First Name

MI

Last Name

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credit card information

Credit Card*

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Credit Card Number*

Expiration Month*

Expiration Year*

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Membership & Billing Terms

By clicking "I agree", you are agreeing that you are signing up for . In addition, you are agreeing to the terms and conditions of the roadside assistance program and authorizing United States Auto Club, Motoring Division, Inc. (USAC/MD) to bill your credit card $ .

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