Use the form below to join Phan Nation!!!

Company

This field is for validation purposes and should be left unchanged.

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone

Email*

Add to our email list?

Club Membership Options*

Select One of the items below to join the Phan Club.

Family (Up to 4 Members in same household) - $25.00

Adult Member - $15.00

Youth Member (ages 1 - 18) - $10.00

Family Members Information

Please fill in the form below with the First/Last Name and emails addresses of your family members joining with your Family Plan! (maximum of four members)

First Name

Last Name

Email Address

Date of Birth

Adult Member Information

Please fill in the form below with the First/Last Name and email of the member.

First Name

Last Name

Email Address

Date of Birth

Youth Member Information

Please fill in the form below with the First/Last Name and Email address of the Youth member.

First Name

Last Name

Email Address

Date of Birth

Any Additional Family Members joining?*

If you are adding more than two additional family members, please consider a family membership.

# of Additional Members

Please enter the # of additional members being added beyond the allowed # per membership level (i.e. If you need a 5th family member above the allowed 4 members)

Price: $5.00

Additional Members information

Please fill in the form below with the First/Last Name and email of the additional members.

First Name

Last Name

Email Address

Date of Birth

Discount Code

Payment Type*

Select how you want to pay for Membership

Credit Card

Cardholder Name

Card Details

Total Purchase of Memberships