Membership

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Membership Form

Please only fill out this section if you would like to give this membership as a gift to somebody else.

Please print all names to be included on membership cards.

Additional people (such as a child, caregiver, grandparent, friend, etc.) may be added for $20 each.
Children ages 12 months and younger do not need membership cards.
Membership cards are non-transferable.
You & Me Membership = Two membership cards
Family Membership = Five membership cards

You & Me - $90

Family - $105

I would like to automatically renew my membership

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First Name *

Last Name *

Email *

Address Line 1 *

Address Line 2

City *

State/Province *

Zip/Postal Code *

Country

Secure Payment

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Gifted From:

Giver Email:

Giver Adress

Giver Town & State

Giver Zip Code

Special Note?

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Member 1 Name and Age *

Member 2 Name and Age *

Member 3 Name and Age

Member 4 Name and Age

Member 5 Name and Age

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Include a submember in your membership registration

Include a submember

SUBMEMBER {{index+1}}: {{getSubMemberName(index)}}

Choose Existing Contact(s)

Membership Level *

I would like to automatically renew my membership

Name *

Age *

Add a submember

Secure Payment

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{{orderSummary.membershipOrderItem.startDate}} - {{orderSummary.membershipOrderItem.endDate}}

{{orderSummary.membershipsTotal==0?'Free':formatAmount(orderSummary.membershipsTotal)}}

Membership auto-renews monthly for {{ formatAutoRenewAmount(orderSummary.membershipOrderItem.membershipInstallment.cost) }} until {{ orderSummary.membershipOrderItem.membershipInstallment.endDate }}

Membership auto-renews on {{orderSummary.membershipOrderItem.membershipAutoRenew.renewDate}} for {{formatAutoRenewAmount(orderSummary.membershipOrderItem.membershipAutoRenew.cost)}}

{{orderSummary.membershipOrderItem.cost==0?'Free':formatAmount(orderSummary.membershipOrderItem.cost)}} {{orderSummary.membershipOrderItem.termName}}

{{orderSummary.membershipOrderItem.startDate}} - {{orderSummary.membershipOrderItem.endDate}}

Membership auto-renews monthly for {{ formatAutoRenewAmount(orderSummary.membershipOrderItem.membershipInstallment.cost) }} until {{ orderSummary.membershipOrderItem.membershipInstallment.endDate }}

Membership auto-renews on {{orderSummary.membershipOrderItem.membershipAutoRenew.renewDate}} for {{formatAutoRenewAmount(orderSummary.membershipOrderItem.membershipAutoRenew.cost)}}

{{sm.userName}} (Submember)

{{sm.startDate}} - {{sm.endDate}}

Membership auto-renews monthly for {{ formatAutoRenewAmount(sm.membershipInstallment.cost) }} until {{ sm.membershipInstallment.endDate }}

Membership auto-renews on {{sm.membershipAutoRenew.renewDate}} for {{formatAutoRenewAmount(sm.membershipAutoRenew.cost)}}

Donation

Discount Code

Code:

-{{formatAmount(orderSummary.codeDiscount)}}

Order summary

Subtotal {{formatAmount(orderSummary.subtotal)}}

Discounts -{{formatAmount(orderSummary.discounts)}}

Total {{formatAmount(orderSummary.total)}}

Secure Payment

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Card

ACH

PayPal

or enter your card details below

Cardholder First Name *

Cardholder Last Name *

Cardholder Email

Card *

Billing address is the same as mailing address

Address Line 1

Address Line 2

City

State/Province

Zip *

Country

Routing Number *

Account Number *

Account Type *

Account Holder First Name *

Account Holder Last Name *

Account Holder Email *

You will be charged

Click this button to make your payment via PayPal.

Note: You will be redirected here once your payment is processed by PayPal.

You will now be taken to PayPal to complete your transaction. Please wait.

Please note: since you are in the testing mode, this Paypal button will direct you to Paypal testing site (Paypal Sandbox) to simulate the payment process. All information is fictitious in Paypal Sandbox and there will be no real transactions. For your convenience, you can use our pre-registered testing account [jhuang@dev.neoncrm.com/Watercube2]. To enter test mode, Paypal Sandbox may need you to log onto Paypal Developer Central first. Please use [jhuang@dev.neoncrm.com/Watercube2] to login.

Amount:

{{formatAmount(totalAmount)}} USD

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	Contact Name	Membership Level
	{{item.contactName}}	{{item.membershipLevel==null?'-':item.membershipLevel}} {{item.startDate}} - {{item.endDate}}
No contacts.