Membership Form
Full Name
*
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
E-mail
*
example@example.com
Signature
Monthly Membership Donation
*
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( X )
USD
Minimum monthly donation is US$1.00
Payment Methods
Debit or Credit Card
Choose from one of the PayPal options to
make your payment.
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