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  • Member Information

    Please complete the following information for the designated individual who will receive the membership benefits thanks to your donation. If you are donating for a designated family, please list an adult who we can contact later for the family's information. 

  • *Which Membership Package are you selecting?
    • *
      First Name
    • *
      Last Name
    • Address1
    • Address2
    • City
    • Zip Code
    • State
    • *
      Phone
    • *
      Email
  • *Members age
  • For members under the age of 18

    Please provide the contact information for a parent/guardian of the minor member.

    • First Name
    • Last Name
    • Address1
    • Address2
    • City
    • Zip Code
    • State
    • Phone
    • Email
  • *Please select your preferred method of payment for your donation.
  • *

    By submitting this membership form you are agreeing to the full Terms & Conditions of Homeroom Education, Inc. which can be found on our website. 

    Please check "Agree" and  sign in the box below acknowledging your acceptance of the Homeroom Education, Inc. Terms & Conditions and that you agree to pay the donation amount request for the membership package you will receive.

  • *

    Provide signature in box below (use your mouse/cursor).

That's all, folks!

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