MEMBER  REGISTRATION
 
   Membership Type:    Cape Cod Health Care 12 Month Membership
   First Month Dues*:    $ 20.42
   Enrollment Fee :    $ 10.00
   Additional Amenities:    $ 0.00
   Total Due Today:    $ 30.42
   Billing Begins:    01/12/2025
   Monthly Dues:    $ 24.99
   Term:     Minimum Commitment 12 electronic payments
 
 PERSONAL  INFORMATION
   
     First Name
     Last Name
     Address
     City / State
     Zip
   
   
Birthday
Cell Phone
E-Mail
Confirm E-Mail
   
 
 EXTRAS
 
 BILLING  INFORMATION
 
    How would you like to pay for your monthly dues?
     I want to use my credit card. ($2 per month service charge)
     I want to use my bank account.

    
    How would you like to pay today?
    Credit Card Type
    Credit Card Number
    Expiration Month/Year /
   
 
 TERMS   AND   CONDITIONS
 
 I have read and agree to the contract terms. click here
 I have read and agree to the billing for membership. click here
 I have read and agree to the annual fee. click here
 I have read and agree to the waiver of liability. click here
 I certify that I am 18 years of age or older.
 
 
Member
 
Parent/Guardian