Membership Application
1
Crear perfil
2
Contrato de miembro
3
Info. personal
4
Otro miembro
5
Selec. del programa
6
Historial médico
7
Revisión
8
Activación
1 of 7
Crear perfil
Next: Contrato de miembro
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or
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Let’s get started by identifying the type of membership that you need. Select from one of the following:
General Membership:
You are the individual that will be responsible for your membership.
Member Only
Member + One
Member + Family
Guardian Membership:
I'm applying as the Guardian of someone else's Membership.
Group Membership:
My Membership is being sponsored by my Group and I have been given a Payment Token.
Please enter last 4 digits of your Social Security Number so we can match you to your Group.
Certifico que estoy completando esta solicitud en mi nombre, como Solicitante, y NO en nombre de otra persona. Entiendo que NO ESTOY AUTORIZADO a completar esta solicitud en nombre de otra persona, y que Impact Health Sharing puede cancelar o negar la membresía y/o el pago de cualquier factura médica elegible asociada con esta solicitud, si esta solicitud se completó el nombre de alguien que no sea yo.
User Registration:
Now let's setup a password for your membership. Your email address will be your username. Please, follow the instructions to complete your application and then activate your account. You can save your application and return back to
mysharable.com
at anytime.
First Name
*
Middle Name
Last Name
*
Email
*
Phone
*
Date Of Birth
*
Password
*
Confirm Password
*
Referral Code/IBO Number
include at least one number and symbol
include both lower and upper case characters
be at least 8 characters with no spaces
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