Individual Membership Application

Please select one option(Required)

Senior $30

Student $35

NEXT $35 (Young Pro)

Individual $60 (Up to 2 as a couple)

Columbia Circle $1000

Name(Required)

First Last

Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Country(Required)

Direct Email(Required)

Phone(Required)

If selecting Individual for 2 people, add below:

Name

First Last

Direct Email

Phone

For couple only: NEXT young pro group

Add us both to NEXT

CAPTCHA

Total

Credit Card

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

This field is for validation purposes and should be left unchanged.