Helmets 4 Kids

MEMBER LEVELS & BENEFITS

Standard Member:

$10 Monthly or $100 Annually

Members Certificate

Bronze Member

$25 Monthly or $250 Annually

Membership Plaque

Silver Member

$50 Monthly or $500 Annually

Silver Membership Plaque, Helmets 4 Kids T-Shirt Includes recognition on our website. (at your request)

Gold Member

$100 Monthly $1000 Annually

Gold Membership plaque. 2 Helmets 4 Kids T-Shirts and recognition on our website & Name on our banner (at your request)

MEMBERSHIP APPLICATION

Submit online or mail to Helmets 4 Kids PO Box 145 Valley Springs SD 57068

Membership Application

Name (First & Last)

Mailing Address

Membership Level

Method of Payment

Cash or Money Order
Check ( subject to $50 returned check charge)
Credit Card
Paypal

Billing Address

Card Type

Card Number

Three Digit Code on Back of Card

Bank Name

Account Number

Signature (typing first and last name counts as electronic signature). I understand that my signature authorizes Helmets 4 Kids to bIll my credit card or bank account according to the membership plan chosen above. The amount for my membership plan will bill automatically either monthly or annually as specified by my chosen membership plan untill such time as I request either by email or in writing to terminate my membership.