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Membership Application

From Dunham-Singletary Family Connections
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<emailform>
 
<emailform>
 
  {|  
 
  {|  
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  | City: || <emailform city=40 />  
 
  | City: || <emailform city=40 />  
 
  |-
 
  |-
  | State: || <emailform state=40 />  
+
  | State/Province: || <emailform state=40 />  
 
  |-
 
  |-
  | Zip/Postal Code: || <emailform zip=10 />  
+
  | Zip/Postal Code: || <emailform zip=40 />  
 
  |-
 
  |-
 
  | Country: || <emailform country=40 />
 
  | Country: || <emailform country=40 />
  |-  
+
  |-
 +
| Phone Number : || <emailform phone=40 />
 +
|- 
 
  | Email: || <emailform email=40 />  
 
  | Email: || <emailform email=40 />  
 
  |-
 
  |-
 
  | Website: || <emailform website=40 /> || (optional)
 
  | Website: || <emailform website=40 /> || (optional)
 
  |-
 
  |-
 
 
  | Comments:
 
  | Comments:
 
  | colspan="2" | <emailform comments=80x8 />
 
  | colspan="2" | <emailform comments=80x8 />
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  |}
 
  |}
 
  </emailform>
 
  </emailform>
 +
'''The annual membership fee is $25.00'''.  After you click on "''Submit Application''" you will be prompted to click on a paypal "add to cart" button to complete your membership renewal.
 
  <emailform result>
 
  <emailform result>
 
  Thanks for your registration.  
 
  Thanks for your registration.  
  
   Your information has been sent us; Please complete payment for membership by clicking on the add to cart button.
+
   Your information has been transmitted; Please complete payment for membership via PayPal by clicking on the add to cart button.
  
  
 
<html>
 
<html>
  
<form target="paypal" action="https://www.paypal.com/cgi-bin/webscr"
+
<form target="paypal" action="https://www.paypal.com/cgi-bin/webscr" method="post">
 
+
method="post">
+
 
<input type="hidden" name="cmd" value="_s-xclick">
 
<input type="hidden" name="cmd" value="_s-xclick">
 
<input type="hidden" name="hosted_button_id" value="W3D6A9HPVGPFL">
 
<input type="hidden" name="hosted_button_id" value="W3D6A9HPVGPFL">
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height="1">
 
height="1">
 
</form>
 
</form>
 
 
</html>
 
</html>
 
 
  </emailform>
 
  </emailform>

Revision as of 12:38, 9 November 2012

Full Name:
Street Address:
City:
State/Province:
Zip/Postal Code:
Country:
Phone Number :
Email:
Website: (optional)
Comments:

The annual membership fee is $25.00. After you click on "Submit Application" you will be prompted to click on a paypal "add to cart" button to complete your membership renewal.

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