World Wellness Education Membership Agreement
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As a member of World Wellness Education, I agree to attend as many meetings as I can and to participate to my ability in the community outreach programs. I understand that the goal of this membership is to educate myself and others in living a life of wellness. I know that a big part of reaching this goal requires me to volunteer on a committee that will serve the overall mission of the club. Membership is for one year and dues are to be paid quarterly or in full. Quarterly payments will be automatically deducted from a checking account or credit card of my choosing. Meetings can be attended at any chapter of World Wellness Education. Signature _____________
Dues are $100.00 Pay in Full:
Authorized Agreement must be completed if payment
is to be paid quarterly.
AUTHORIZED AGREEMENT FOR PREAUTHORIZED PAYMENTS FOR DUES I (We) hereby authorize the Wellness Educational, Org. hereinafter called COMPANY, to initiate debit entries, and corrections thereto my (our) checking, savings or charge card account indicated below and the depository credit card named below, hereinafter called DEPOSITORY. Name_______________________ Expiration Date____________
Credit Card/Debit Card Number ___________
Annual Payment ($100.00) _____ or Quarterly Pmt($25.00 per quarter) ____ * Dues may be pro-rated depending on the date of membership. This authority is to remain in full force and effect until COMPANY and DEPOSITORY have received written notification from me (or either of us) of its termination in such time and in such manner as to afford COMPANY AND DEPOSITORY a reasonable opportunity to act on it, or until all payments due under the contract have been made. Signature_______________
TO BE COMPLETED BY CHAPTER TREASURER ONLY: Paid in Full: Date: st
Paid Quarterly: 1 Qtr Paid: 3rd Qtr Paid:
2nd Qtr Paid:
4th Qtr Paid:
Give to local club president or fax to (352) 365-6376 Addendum T
Published on Apr 17, 2010