Test form Signups
| Status | Future |
|---|---|
| Misc Member Notes | George H Meyers inactive October 29th 2015. AK Member mailed in a renewal for $89.95, rcv'd CASH20 exp, but already renewed. Addresses different between renewals. Called and LVM. 11/25/2020 MT Spoke w/ Doris, explained what happened and let her know her options. She said we can go ahead and renew the check electronically for $79.95. Giving info to Jon to process electronically. 11/30/2020 MT ExMail 1-3-17, ExMail 2/6/19, ExMail 3/11/2020, ExMail CASH20 Renew 11/30/2020, ExMail 05/24/22, ExMail 6/14/23, ExMail 08/02/24, |
| Membership Type | Individual Plan ($99.95) |
| Are you renewing your plan? | Yes |
| Please enter your current membership ID# here. You can find this in your renewal email or on your current membership card. | 1756305570 |
| Your Name | Doris A Meyers |
| Email hidden; Javascript is required. | |
| Phone | (734) 284-9359 |
| Date of Birth | 08/09/1941 |
| Referred by or Referral Code | ExMail 09/29/26 |
| Enter Office Code | A20829 |
| Address | 15755 Cynthia St Southgate, MI 48195 Map It |
| Payment Method | Check |
| Payment Received | Paid |
| Total | $99.95 |
| Go Green | Paperless Option | not |
| Terms |  I have read the Terms and Conditions and wish to purchase the Discount Medical Plan. |
| Plan Information | |
| Newest Membership: Programmatically pick Plan Start Date Based on either new plan or their ID number here | 11/08/2026 |
| Newest Membership: Programmatically pick Expiration Date Based on either new plan or their ID number here | 12/08/2027 |
| Membership ID Number | 1790698232 |
| Past Plan Information | this probably isn't needed there should already be additional entries |
| Resend Sign Up Email | 8 |
| HTML Block | ***After clicking submit please wait 10 seconds for the form to process. Thank you. *** |
