Gift Membership
Select a Level
$35 Student
$75 Individual/Dual
(Senior rate $67.50)
$100 Family/Grandparent
(Senior rate $90)
$150 Sponsor
(Senior rate $135)
$300 Patron
(Senior rate $270)
$600 Benefactor
(Senior rate $540)
$1,000 Ambassador
(Senior rate $900)
Total first section levels
Promo Code
Total with MEMBER100
Apply Senior Discount
Yes
No
Senior Discount
Senior Discount Amount
Total with Senior Discount
Final Total
Total amount to be charged on page 3
Campaign ID
Lead Source
Recipient Information
Please enter the gift recipient(s) contact information below.
Member One
First Name
Last Name
Email
Phone
Mailing Street Address
Mailing City
Mailing State
Please select...
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Mailing Zip/Postal Code
I do not have a second member name and would like the second membership card to be for a guest.
Member Two
First Name
Last Name
Email
Phone
Gift Notification Message
Would you like to add a special note for the gift recipient(s)?
Membership Card Options
How would you like to receive your membership card(s)?
Plastic membership card only
Digital membership card only
Both plastic and digital
Kid/Grandkid Cards
Kids/Grandkids Card One
First Name
Last Name
Kids/Grandkids Card Two
First Name
Last Name
Kids/Grandkids Card Three
First Name
Last Name
Kids/Grandkids Card Four
First Name
Last Name
Your Billing Information
Please enter your billing information in this section.
Gift Giver First Name
Gift Giver Last Name
Gift Giver Email
Gift Giver Phone
Billing Street Address
Billing City
State/Province
Billing Zip/Postal Code
My mailing address is different than my billing address
Yes
Contribution Summary
MEMBERSHIP CONTRIBUTION
Student Membership: $35
Individual/Dual Membership: $75
Family/Grandparents Membership: $100
Sponsor Membership: $150
Patron Membership: $300
Benefactor Membership: $600
Ambassador Membership: $1,000
Credit Card Information
Amount to be charged
Credit Card Number
CVV
Expiration Month (MM)
Expiration Year (YYYY)
Your credit card will be charged when you hit submit.
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