Health Freedom Iowa Membership Application Form

Membership Application

To apply for membership to Health Freedom Iowa, please complete all questions. This form *MUST* be completed before being admitted to the private Facebook group.
Name

First Name Last Name
Name as appears on Facebook

First Name Last Name
E-mail
Phone Number
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Please List any Friends you have in the Facebook Group
What Health freedom topics are important to you?
I am interested in volunteering for the following activities:
YOU WILL RECEIVE A PAYPAL REQUEST FROM healthfreedomiow@gmail.com IF YOU CHOOSE A PAID MEMBERSHIP LEVEL UNLESS YOU HAVE PAID THROUGH OUR WEBSITE WWW.HEALTHFREEDOMIOWA.ORG/JOINUS
Membership Level
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Community Membership Free

Monthly Membership - Needs to be paid monthly $ 5.00

Annual Membership $ 60.00

Lifetime Member $ 1,200.00
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