Sample Sale #5 – Memberlite Demo

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You have selected the Benefactor membership level.

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The SAMPLESALE1 code has been applied to your order.

The price for membership is $5.00 per Month.

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First Name

Last Name

Address 1

Address 2

City

State

Postal Code

Country

Phone

E-mail Address

Confirm E-mail

Card Number

Expiration Date /

Security Code (CVC) (what's this?)

Discount Code

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