Benefactor (Auto-renew) Membership

Please enter your information on the form below to process your Benefactor (Auto-renew) SAPFM membership.

Show on Members List?

Email (used as your login name) *

Password*

Retype Password *

First Name *

Middle Name

Preferred Name

Last Name *

Suffix

Primary Chapter *

Secondary Chapter

Tertiary Chapter

Address *

Address2

Zip *

Country *

City *

State *

Phone (Area/Country Code + Number)

How did you hear about SAPFM?

Alternate Email (optional)

I live outside of the US and Canada

$20.00

Benefactor Donation
(minimum donation $100)

Payment Terms

$125.00 for each year

Membership price

Regular membership discount amount

Regular membership tax

Payment Fee

Regular gross amount

Payment Method

Paypal

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Holder Name*

Captcha*