“Your Passport to Value and Savings” Monthly Membership Annual Membership First Month Free Enrollment Fee $ 10.00 Total Charge $ 10.00 First Month Free Enrollment Fee $ 10.00 Annual Fee $ 100.00 Total Charge $ 110.00 The registration process is a very important part of the program. The more we know about our members, the better we can represent them in the process of building the network and negotiating discounts. Please provide all of the information requested, including a secondary email address as well as cell phone number. You may be wondering why we are requesting these items? A vital part of the Vpass program is what we call Vmail and Vtext. As we secure new discounts and special deals for members we will let you know via email and text messaging. Therefore, if you use your employer provided email address as your primary and you leave employment, we need a secondary address to stay in touch. If at any time you would like to discontinue or opt out of the Vmail and Vtext notification process, simply login and check the opt out box in your member profile.

	Card Number:
	Date Created:
	Legal Name as Listed on Goverment Issued ID
	First Name: *		Home Phone:
	Middle Name:		Work Phone:
	Last Name: *		Cell/Mobile Phone:
	Suffix:
	Date of Birth: *	MM/DD/YYYY
			Street Number:
	Primary Email: *		Street Name:
	Secondary Email:		Road/Drive/Avenue:
			Apt./Unit/Suite:
			* City:
			* State Abbreviated:
			* Zip Code:
	Spouse Y/N:
	Spouse Name:
	How Many Children Under Age 18:	0 1 2 3 4 5 6 7 8 9 10 11 12 12+
	Expecting Y/N:
	Pets Y/N:
	Own Home Y/N:
	Need for Insurance Y/N:
	Opt Out Emal:
	Opt Out Text: