YES!  I want to accept this special invitation to receive Palmer Advantage benefits.

By accepting this invitation, and submitting this enrollment form, I understand that I am subject to the additional monthly dues of $20.00, and the terms and conditions of Palmer Advantage, which are available online at http://www.palmeradvantage.com/terms-conditions/

Primary Member Name (First & Last):*

Spouse Name (First & Last):

Phone Number*

Primary Member Email:*

Spouse Email:

* Indicates a required field.

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