2022 Membership

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MANASD Membership Form

Please help us best serve our members by answering the following questions.

If you are choosing a company membership, please list the name and email address of the representative who will be the POC for the organization.

I.e. the company is MANASD and Inez is the representative.

First Name *

Last Name *

Submit as a company

Company Name *

Enter the name of your employer

Email *

Phone 1 *

Address Line 1

Address Line 2

City

State/Province

Zip/Postal Code

Country

Consent to Receive Communication *

By clicking yes, you agree to receive our monthly newsletter and periodic e-blasts with pertinent information.

Include me in the Member Directory *

By clicking yes, your name and any information you CHOOSE to share with other members will be visible on our Member Directory located on the Member Portal.

Secure Payment

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Include a submember in your membership registration

Include a submember

SUBMEMBER {{index+1}}: {{getSubMemberName(index)}}

Choose Existing Contact(s)

Membership Level *

I would like to automatically renew my membership

Birthday *

Gender *

First Name *

Last Name *

Email *

Add a submember

Secure Payment

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Membership auto-renews monthly for {{ formatAutoRenewAmount(orderSummary.membershipOrderItem.membershipInstallment.cost) }} until {{ orderSummary.membershipOrderItem.membershipInstallment.endDate }}

Membership auto-renews on {{orderSummary.membershipOrderItem.membershipAutoRenew.renewDate}} for {{formatAutoRenewAmount(orderSummary.membershipOrderItem.membershipAutoRenew.cost)}}

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Membership auto-renews monthly for {{ formatAutoRenewAmount(orderSummary.membershipOrderItem.membershipInstallment.cost) }} until {{ orderSummary.membershipOrderItem.membershipInstallment.endDate }}

Membership auto-renews on {{orderSummary.membershipOrderItem.membershipAutoRenew.renewDate}} for {{formatAutoRenewAmount(orderSummary.membershipOrderItem.membershipAutoRenew.cost)}}

{{sm.userName}} (Submember)

{{sm.startDate}} - {{sm.endDate}}

Membership auto-renews monthly for {{ formatAutoRenewAmount(sm.membershipInstallment.cost) }} until {{ sm.membershipInstallment.endDate }}

Membership auto-renews on {{sm.membershipAutoRenew.renewDate}} for {{formatAutoRenewAmount(sm.membershipAutoRenew.cost)}}

Donation

Discount Code

Code:

-{{formatAmount(orderSummary.codeDiscount)}}

Order summary

Subtotal {{formatAmount(orderSummary.subtotal)}}

Discounts -{{formatAmount(orderSummary.discounts)}}

Total {{formatAmount(orderSummary.total)}}

Secure Payment

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Card

ACH

or enter your card details below

Cardholder First Name *

Cardholder Last Name *

Cardholder Email

Card *

Billing address is the same as mailing address

Address Line 1

Address Line 2

City

State/Province

Zip *

Country

Routing Number *

Account Number *

Account Type *

Account Holder First Name *

Account Holder Last Name *

Account Holder Email *

Amount:

{{formatAmount(totalAmount)}} USD

({{formatAmount(amexTotalAmount)}} USD for AMEX cards)

Secure Payment

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Contact us
T: 619.297.0115
404 Euclid Ave, Suite 308
San Diego, CA 92114
E: manasd@manasd.org

Membership level allows for a maximum of {{term.subMemberAllowed}} submembers.

	Contact Name	Membership Level
	{{item.contactName}}	{{item.membershipLevel==null?'-':item.membershipLevel}} {{item.startDate}} - {{item.endDate}}
No contacts.