Membership Fees Payment Plan

Membership Fees Payment Plan
Thank you for your interest in setting up a payment plan for your membership fee! Please fill out the form below and make your first monthly payment. Please feel free to contact the National Office at 614-488-4094, or email Ben Flox at bflox@mortarboard.org with any questions.
Member Information
Name*

First NameLast Name
College or University*
Phone Number*

Area CodePhone Number
Email*
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Payment Information

Payment plan length*

4 Payments($20.00 for each month)

Four (4) monthly payments of $20.00.

5 Payments($16.00 for each month)

Five (5) monthly payments of $16.00.

2 Payments($40.00 for each month)

Two (2) monthly payments of $40.00.

Total $0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year