Associate Membership Application

Member Information

* - Indicates required fields

Full Name *

Email *

Phone *

Address *

Address 2

City *

State *

ZIP *

Membership Fee Amount $

Credit Card Administration Fee Amount $

TOTAL CHARGE TO CREDIT CARD $

Credit Card Information

Membership fees total to $100. By placing your card information and submitting this form, you give SDPhA permission to charge $100 to your card.

An administrative fee of 3% will be applied to all transactions.

Cardholder Name *

Card Number*

Expiration Month *

Expiration Year *

CVV# *