MAIL IN APPLICATION FOR MEMBERSHIP
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MI
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$49.95 per year Individual Rate: This rate is for one person
$99. per year Family Rate: This rate is for you, your spouse and children
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If you wish to pay for Annual Membership by Check or Money Order please attach the full amount to this form when mailing
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Community Action Program
No Extra Charge to you! Our way of saying thanks.
Qdrug and The HealthPlus Network of Providers will donate 10% of this sale to one of the charitable foundations below. These foundations focus on helping children in the United States who are stricken Cancer, Aids and Abuse. Click Here for Foundation information.There is no extra charge to you for checking a box below. It is our way of giving back to the community. If one is not check then we will select one in random order. Thank you
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St Jude Children's Hospital
Tomorrow Children Fund
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FAX to: 480-807-5958
This form is for ordering by Mail only! If you wish to sign up using our secure credit card server please click HERE