Service Partners Monthly Program

Name*

First Last

Email*

Chapter*

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Chapter Leader

Would You Like A Free Member Card?*

If you choose to receive the welcome pack with member card, we just ask that you pay $4.95 to cover shipping & handling. You DO NOT have to have a welcome pack to become a member.

Yes, send me the welcome pack

No, thank you.

Address*

Where should we ship your free membership card?

Street Address Address Line 2 City State ZIP Code

Billing Address*

Same as shipping

Different address

Seperate Billing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Welcome Pack Shipping & Handling*

Price:

Credit Card

Card Details

Cardholder Name

Choose Your Username*

Password*

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