Natural Awakenings Network (NAN)
Subscriber/Cardholder Registration Form
VegMichigan Members and Email List Subscribers

A special program just for VegMichigan members and VegMichigan email list recipients. Here's what you receive:

• Special discounts off the regular NAN Discount Card program rates
• Full NAN Discount Card program discounts of 5-50% from our national network of providers
• Full access to the NAN Discount Card program online directory of providers
• Membership cards for yourself (individual membership), up to 4 members of your famiy (family plan) or larger groups if you wish (inquire for info)
• The chance to further support VegMichigan. We donate 20% of your NAN Discount Card program registration fee to VegMichigan!
• A monthly newsletter with specials, news and other information to help make your NAN Discount Card work for you and save you money!

Please complete the information below. Enter all field. If not applicable enter (n/a):

Your Last Name:

Your First Name:

Sex:

M F

Your Date of birth:

Home Address

City

State

Zip Code

E-mail:

Telephone

Choose your VegMichigan promotional plan (introductory discounts shown):

• VegMichigan Registered Cardholder:
Individual Plan: $25 Annual (reg. $108 Annual less 77%)
Family Plan: $99 Annual - up to 4 persons (reg. $216 Annual payment less 54%)
I would like more than 4 subscriptions (group plan). Please contact me.

• Not a VegMichigan Member?
if you wish, you can JOIN VEGMICHIGAN NOW (a new window will open to register with VegMichigan, then finish this form)

If Family Plan chosen, list up to 3 additional members (max 4 total including main member)

AGREEMENT: By entering my digital signature below and completing payment, I hereby subscribe as a cardholder to the Natural Awakenings Network (NAN). This subscription is in effect for one year from the date of entering your name/date below (you will be sent a renewal reminder during the last month of your subscription). Your digital signature is considered binding and shall be construed as your original signature for all purposes of this agreement.

Enter your name as your digital signature: Today's date:

Note: Upon receipt of this form, and payment, a copy of this agreement will be emailed to you at the email address entered above. Allow 7-10 days for receipt of your cards.

Please enter, exactly as shown, the dark black text/numbers from the image next to the box below, then click the "Submit Email" button below to send us the information you entered. Thank you!