Individual Membership Form

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MEMBERSHIP
PROGRAMS
{{profilePhoto.url?'':accountBasicInfo}}
- MY PROFILE
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Include a submember in your membership registration

First Name *

Last Name *

Submit as a company

Company Name

Address Line 1

Address Line 2

City

State/Province

Zip/Postal Code

Country

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Include a submember

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

Choose Existing Contact(s)

Membership Level *

I would like to automatically renew my membership

First Name *

Last Name *

Address Line 1

Address Line 2

City

State/Province

Zip/Postal Code

Country

Add {{subMemberDisplayName}}

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}} ({{subMemberDisplayName}})

{{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)}}

Frequency selected: {{recurringUnitText}}. Next add-on payment processes on {{orderSummary.recurringDonationNextDate}} for {{formatAmount(orderSummary.donationAmount)}}

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

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Cardholder First Name *

Cardholder Last Name *

Cardholder Email

Card *

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Billing address is the same as mailing address

Address Line 1

Address Line 2

City