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MEMBER & PLAN INFORMATION
First Name (required)
Last Name (required)
E-Mail Address (required)
Phone
Membership Plan
Create Username
Create Password	(Letters & Numbers Only)

CREDIT CARD INFORMATION
Name on Credit Card
Card Type
Card Number
Expiration Month	(2 digit)
Expiration Year	(4 digit)
Validation Code
Billing Address
Billing City
Billing State/Province/Territory
Billing Zip/Postal Code
Billing Country

COMMENTS / SPECIAL INSTRUCTIONS
Comments

TERMS & CONFIRMATION
I understand I am signing up for a club membership with the Genesis Group (dba Camera Genesis). I understand that my credit card will be billed monthly for the above monthly membership rate and that my credit card statement will show this charge as the Genesis Group. I understand I can cancel my membership before the first day of the next month and I will not be billed for that month. I understand that if I cancel after the first day of a month, I will be billed for that month in its entirety and will not be entitled to any prorated refund. I understand that until I cancel my membership in writing or via email, I will be billed monthly, regardless of whether I have used any services of the club or not.
I AGREE

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