I Am Well Darke County Membership
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Please select your membership level below. Your card will be charged monthly or annually depending on your selection, and you can cancel by emailing us at info@iamwellfoundation.org. When you click submit, you will be taken to our payment gateway, where you can pay with PayPal or scroll down to pay with Credit/Debit Card.
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Basic Membership (Monthly)
$
20.00
for each
month
Basic Membership (Annual)
Includes 2 months FREE when you purchase your annual membership up front.
$
200.00
for each
year
Submit
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