Membership Renewal

Request Date:

2024/11/21

Membership Type:

Member ---- $30.00 /year

Membership Period:

October 01, 2024 - March 31, 2025

Membership No.:

Phone Number:

(

)

Last Name:

Payment Amount:

$15.00

Payment Method:

Online (You may pay by your Credit Card without creating a PayPal account)

I have read and agree to release Carefirst Seniors and Community Services Association and Carefirst Foundation and their directors, officers, employees, and agents form any claims damages, costs, expenses or any other liability arising from any injury or damage to my person or property sustained as a result of my participation in any activities held at any locations.

Note: All fields marked with

are required.

Please notify us of a change of personal information, e.g. address, telephone number, email

Membership Renewal

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Carefirst Wellness Club