Test form Signups
| Status | Future |
|---|---|
| Misc Member Notes | Fixed her plan dates 9/5/23 EK Got check to renew, already did with Paypal. Called and spoke w/ member, asked us to mail back. Sent. 12/30/25 MT |
| 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. | 1766501619 |
| Your Name | Patricia Conover |
| Email hidden; Javascript is required. | |
| Phone | (972) 523-1506 |
| Date of Birth | 05/01/1951 |
| Address | 6675 Mediterranean Dr Unit 3504 McKinney, TX 75072 Map It |
| Payment Method | PayPal |
| 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 | 01/28/2027 |
| Newest Membership: Programmatically pick Expiration Date Based on either new plan or their ID number here | 02/28/2028 |
| Membership ID Number | 1792538133 |
| Past Plan Information | this probably isn't needed there should already be additional entries |
| Resend Sign Up Email | 7 |
| HTML Block | ***After clicking submit please wait 10 seconds for the form to process. Thank you. *** |
| Payment Method | PayPal Checkout |
