EmailMeForm
*Family Membership Agreement
The Power of Working Together
1970 W Old Magee Trail, Suite 9201
Oro Valley, AZ 85704
Phone 800 743 4731 - Fax 888 743 4731
Email Address: Info@powt.org
CLICK HERE to print a hard copy for your records if you wish.
We will also provide you a copy by email when you submit the eletronic form below.
Accept our funding assistance offer NOW and complete your membership request below and submit. Fields marked with a red * are required for submission.
PERSON REQUESTING FUNDING please complete and submit this form below. You will receive instructions from our director advising you of the next steps to get the process started.
Applicant 1 Name
*
First
Last
Applicant 1 Cell Phone
*
###
-
###
-
####
Applicant 2 Name
First
Last
Applicant 2 Cell Phone
###
-
###
-
####
Applicant 1 Email
*
Applicant 2 Email
Applicant(s) Address
*
Street Address
City
State / Province / Region
Postal / Zip Code
Family Members to be included under age 24
Full Name
Date of Birth
Personal Email
Cell Phone
Student
Student
Student
------------------------------------OUR COMMITMENT ------------------------------------
--------------------------------- YOUR COMMITMENT ----------------------------------
CLICK HERE TO UNDERSTAND "Promise of Value"
*
I understand the PROMISE OF VALUE
**CLICK HERE**
for one SINGLE PAYMENT
Your billing will read *MARKET CONSULTANTS
Preferred Enrollment Method is Checking or Savings Account - WE WILL CONTACT YOU TO SEND YOUR PAYMENT LINK BASED ON YOUR SELECTION BELOW.
Signature ~ Email may be used
*
Submitted on a secure server and a copy of the agreement will be emailed to you for your records. Submission verifies your IP address.
Date
*
MM
/
DD
/
YYYY
Choose PAYMENT that works best for you.
*
Please select one - we will invoice you upon submission.
Single Annual Payment $2,000
Payment Plan 5 months @ $500
Please Select
