MEMBERSHIP PAYMENT

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Membership Payment

NOTICE: After paying for my membership, I agree to print, complete and mail my Membership Application to CHRISTUS EMS 2201 Mobberly Avenue, Longview, TX 75602. My Membership is subject to cancellation if my application is incomplete and/or not sent to CHRISTUS EMS for processing. By marking the “I agree” check box, I am indicating that I have read and agree with this statement and the statements printed on CHRISTUS EMS’ Membership application. Once you click “I agree” checkbox below, the online payment section will appear.

I agree

I want to:*

Apply for a new membership

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Name

Physical Address:

City

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Membership ID

(If already a member)

Amount*

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