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

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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

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Include a submember in your membership registration

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Choose Existing Contact(s)
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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)}}
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{{orderSummary.membershipOrderItem.userName}}
{{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)}}
{{orderSummary.membershipOrderItem!=null?smIndex+2:smIndex+1}}
{{sm.userName}} ({{subMemberDisplayName}})
{{sm.cost==0?'Free':formatAmount(sm.cost)}} {{sm.termName}}
{{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)}}
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Frequency selected: {{recurringUnitText}}. Next add-on payment processes on {{orderSummary.recurringDonationNextDate}} for {{formatAmount(orderSummary.donationAmount)}}

Discount Code

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 Code:
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Order summary

Subtotal {{formatAmount(orderSummary.subtotal)}}
Discounts -{{formatAmount(orderSummary.discounts)}}
Total {{formatAmount(orderSummary.total)}}
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Card
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or enter your card details below
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You will be charged

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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.

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