Apply for Choose Life Membership & License Plate

Step 1

1. Fill-out the form below.
   1. Use left form for payment online
   2. Use right form for payment by check
2. Click “Submit Button
   1. Complete online payment by credit card or PayPal or
   2. Prepare check for payment. Details below.

Step 2 (After completing form below)

1. Print DMV-613 form. (Answers to some questions about organizational license plates, see back of DMV-613 form).
2. Mail DMV-613 form along with check if paying by check to:
   • • • • Choose Life Delaware
         • 129 Brandywine Drive
         • Dover, DE 19904
         1. Payment is $30 (If not paid online)
            1. $20 Choose Life Annual “Supporter Fee” and
            2. $10 for license plate (Choose Life will mail a $10 check and your DMV 613 form to the State of Delaware DMV.