Transition Membership Application Form


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Women's Community Transition Membership Application

We respect your privacy. The personal information requested below is for use in processing your credit card, which is done with secure encryption. We never reveal, share, or sell member information. For complete details see our Privacy Statement.

Customer Information

* = Required - Must match credit card billing address!

First Name [ required ]
Last Name [ required ]
Company Name
Address Line 1[ required ]
Address Line 2
City [ required ]
State [ US & Canada ]
State/Province [ All other Countries ]
Zip/Postal Code [ required ]
Country [ required ]
Your E-mail Address [ required ]
Phone Number [ required ]

Membership Plan Option

Membership Plan:	Option One: Pay a one-time fee of $195 and save over 30%! Your benefits are over $4000. My personal guarantee: take the 3-Step Power Partnership System and if you apply the system and you do not get results, just return the materials and I will happily give your money back! Option Two: Pay $16.75 per month and a one-time initiation fee of $99. Your benefits are over $4000! My personal guarantee: take the 3-Step Power Partnership System and if you apply the system and you do not get results, just return the materials and I will happily give your money back!

Choose LOGIN Name [ required ]

Choose PASSWORD [ required ]at least six characters long, using alphas and numbers, no spaces.

Confirm PASSWORD [ required ]

Payment Information

Payment Method [ required ]
Credit Card Number [ required ]
Credit Card Security Code [ required on (MC/Visa/AMEX) What is this? ]
Expiration Date [ required ]	/
Name on Credit Card [ required ]
Is this a Renewal?
Do you wish to receive email alerts?
Referrer Code [ Person's Name ]
Affiliate Referrer [ Affiliate Code ]
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NOTE: It can take up to a minute to process the credit card information and obtain approval. Please do not press the submit button multiple times - doing so could cause double billing.
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