Club Membership Registration Form

Senior Assistance Plan Membership Registration

Complete the form below to sign up for our membership service.
Name

First NameLast Name
E-mail
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

City

Zip Code
Membership Type
Preferred way to contact
1. Membership is available to anyone 55 years of age or older.

2. Once registered, you will receive 12 months of technical support at your residence depending on your service request.

3. You will receive assistance with your internet connection,TV connection, home phone service connection, streaming device and much more. There is no additional cost or fees on any repairs or assistance.

Senior Assistant plan (SAP)

$40.00 for each year

Senior Assistance Plan Membership Registration