Your Name Your Email Mailing Address Billing Address (if different from mailing) Returning Member? Returning MemberNew Member Type of Membership Friend ($50 annually or $5 monthly)Buddy ($75 annually or $8 monthly)Bestie ($125 annually or $12 monthly)Hero Status ($200 annually or $19 monthly) Annual or Monthly (monthly memberships are billed each month) AnnualMonthly If you are choosing to pay monthly, please select what day of each month to automatically charge your card: Card Info: This is a secure form but if you prefer to contact us directly for us to take payment over the phone, please email suzy@wearelaunchpad.org Card Number Expiration Date CVV/CVV2 Number Billing Zip Code Additional Notes: (optional) Thank you! After submitting this form, someone from our staff will follow up to confirm! For any questions please contact our Development & Membership Coordinator, Suzy Violette, at suzy@wearelaunchpad.org Δ
