New Individual Membership Application

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

Comments

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