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Couples Membership Application

for Lifetime Membership $500 *

* $15.00 added to cover processing fee


All Fields Required
Mail Address: DOB:
City: State: Zip:
Phone: Email:

Please list partners name and birth date:

To validate your input please enter the characters in the box below

Image verification

If you cannot read the image, click for a new one
When you submit your application you will be taken to a Secure
Payment Page at Paypal where you can pay with Credit Card or
an exisiting Paypal Account.

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