New Membership Form - Wayshowers Community Fellowship

Membership Date (Hidden)*
Date Format: MM slash DD slash YYYY
Select your Membership Type:*
- Regular Corporate Membership ($50)
- Board of Directors Membership ($100)
50% Discount for Regular Memberships, if applicable: Youth under 21, Sage over 63, and Disabled (SS/Vet)
Do any of these apply to you?*
- I am a youth or young adult under the age of 21.
- I am over the age of 63.
- I am disabled (SS or Veteran).
- None of these apply.
Member Contact Information
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Cell Phone*
Phone
Email*
Birth Date*
Member Login Information
Username*
Please note username must be unique and can not be changed. Email address provided above will be the email for your user account as well as WCF communications.
Password*
Enter Password Confirm Password

Strength indicator
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Member Contact Information