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This form has seven sections. Fill in each section and click Next at the bottom of the form.

For US citizens, choose from the four US options.
For Canadian citizens, choose from the four Canada options.

To move to the next step, you are accepting automatic renewal. You can change this after you become a member.

US Monthly USD $30

US Quarterly USD $85

US Semi Annual USD $160

US Annual USD $300

Canada Monthly CAD $30

Canada Quarterly CAD $85

Canada Semi Annual CAD $160

Canada Annual CAD $300

I would like to automatically renew my membership

Secure Payment

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First Name *

Last Name *

Email *

Phone 1 *

Address Line 1 *

Address Line 2

City *

State/Province

Zip/Postal Code *

Country *

Secure Payment

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Men's Team *

Select the Men's Team you are joining. If you do not know what it is select "Not Known" or if you are not on a Team select "Not on an MDI Team"

Other Team information

If your team is not listed enter your team name or, if you do not know your team name, enter the names of men who are on your team so we can help put you on the correct men's team.

Occupation

Skills that you can help other men with

Secure Payment

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Liability Waiver *

By affixing your ELECTRONIC SIGNATURE here, you are accepting, without changes of any kind, the LIABILITY WAIVER displayed above or on the right.

Type your name to agree to the Liability Waiver *

Secure Payment

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Include a submember in your membership registration

Include a submember

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Choose Existing Contact(s)

Membership Level *

I would like to automatically renew my membership

First Name *

Last Name *

Email *

Address Line 1 *

Address Line 2

City *

State/Province *

Zip/Postal Code *

Country *

Add a submember

Secure Payment

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Membership auto-renews on {{orderSummary.membershipOrderItem.membershipAutoRenew.renewDate}} for {{formatAutoRenewAmount(orderSummary.membershipOrderItem.membershipAutoRenew.cost)}}

{{sm.userName}} (Submember)

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Membership auto-renews on {{sm.membershipAutoRenew.renewDate}} for {{formatAutoRenewAmount(sm.membershipAutoRenew.cost)}}

Donation

Discount Code

Code:

-{{formatAmount(orderSummary.codeDiscount)}}

Order summary

Subtotal {{formatAmount(orderSummary.subtotal)}}

Discounts -{{formatAmount(orderSummary.discounts)}}

Total {{formatAmount(orderSummary.total)}}

Data Privacy & Consent

Yes, I would like to receive communications from Mentor Discover Inspire (MDI) by email.

Yes, I would like to receive communications from Mentor Discover Inspire (MDI) by phone.

Yes, I would like to receive communications from Mentor Discover Inspire (MDI) by mail.

Yes, I would like to receive communications from Mentor Discover Inspire (MDI) by SMS.

Mentor Discover Inspire Privacy Policy

Secure Payment

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Card

Pay Later

Cardholder First Name *

Cardholder Last Name *

Cardholder Email *

Card Number *

Expiration (MM/YY) *

CVV *

Billing address is the same as mailing address

Address Line 1

Address Line 2

City

State/Province

Zip

Country

I will mail in a check or money order

Please mail your payment to:

924 Empire Rd

Poland , ME 04274

Data Privacy & Consent

Yes, I would like to receive communications from Mentor Discover Inspire (MDI) by email.

Yes, I would like to receive communications from Mentor Discover Inspire (MDI) by phone.

Yes, I would like to receive communications from Mentor Discover Inspire (MDI) by mail.

Yes, I would like to receive communications from Mentor Discover Inspire (MDI) by SMS.

Mentor Discover Inspire Privacy Policy

Amount:

{{formatAmount(totalAmount)}} USD

Secure Payment

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Membership Form

Liability Waiver

Membership level allows for a maximum of {{term.subMemberAllowed}} submembers.

	Contact Name	Membership Level
	{{item.contactName}}	{{item.membershipLevel==null?'-':item.membershipLevel}} {{item.startDate}} - {{item.endDate}}
No contacts.