Member | Legal Directives

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First Name *

Middle Name

Last Name *

Address *

City *

State *

ZIP Code *

Date of Birth *

Email *

Cell Number *

Mother’s Maiden Name - Last Name Only *

Select Membership Term *

1 Year Membership - $35 2 Year Membership - $55 5 Year Membership - $115

After Completing the Sign Up, you will have immediate access to your account to store your healthcare directives, emergency contacts, allergies, medical conditions and physician information.

You will receive an email confirmation with your login instructions, and a wallet card will also be mailed to you providing you and healthcare providers 24/7 access to your stored healthcare directives and emergency information.

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