Membership With The Victoria 100 Club
Recipient's Info
(Used For Sending Purchased Items)
Recipient's Name
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Last Name
Recipient's Mailing Address
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Street Address
Street Address Line 2
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Recipient's Email
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example@example.com
Recipient's Phone Number
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Purchaser's Info
(Used Or Billing Purpose)
Purchaser's Name
*
First Name
Last Name
Purchaser's Billing Address
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Street Address
Street Address Line 2
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Purchaser's Email
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My Products
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Register For A New Single Year Membership
$
100.00
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Item subtotal:
$
0.00
Register For A Renewal Single Year Membership
$
100.00
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$
0.00
Register For A Couple's Renewal Single Year Membership
$
150.00
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Item subtotal:
$
0.00
Register For A New Couple's Single Year Membership
$
150.00
Quantity
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Item subtotal:
$
0.00
Register For A Single LifeTime Membership
$
1,000.00
Quantity
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Item subtotal:
$
0.00
Register For A Couple's LifeTime Membership
$
1,500.00
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Item subtotal:
$
0.00
Payment Methods
Debit or Credit Card
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