Violet E. Carlson Memorial Guild Membership Dues
Membership Level
Active Member
$ 20.00
Supporting Member
$ 30.00
$
*
Frequency:
Weekly
Monthly
Quarterly
Annually
On:
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Starting:
Ending:
Ending:
Billing Information
Title:
Admiral
Ambassador
Bishop
Brother
Canon
Capt.
Cdr.
Chaplain
Chef
Chief Justice
Council Member
Dr.
Father
Judge
Madam
Mother
Mr.
Mrs.
Ms.
Pastor
Professor
Rabbi
Reverend
Sen.
Sgt.
Sir
Sister
The Hon.
First name:
*
Middle name:
Last name:
*
Country:
Canada
United States
*
Address lines:
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City:
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State:
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AA
AE
AL
AK
AB
AS
AP
AZ
AR
BC
CA
CZ
CO
CT
DE
DC
FM
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MB
MH
MD
MA
MI
MN
MS
MO
MT
NE
NV
NB
NH
NJ
NM
NY
NL
NC
ND
MP
NT
NS
NU
OH
OK
ON
OR
PW
PA
PE
PR
QC
RI
SK
SC
SD
TN
TX
UT
VT
VIC
VI
VA
WA
WV
WI
WY
YT
*
ZIP:
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Phone:
Email:
*
Payment Information
Cardholder's Name:
*
Credit Card Number:
*
Card Type:
Visa
American Express
Discover
MasterCard
*
Card Expiration:
01
02
03
04
05
06
07
08
09
10
11
12
/
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
*
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