ThePapCorps

Papanicolaou Corps for Cancer Research Logo

Fountains WellSpring Membership

Use the form below to join or renew your Fountains WellSpring membership.

If you have any questions about Membership or would like to pay for yours via check, please contact Laura Edelman at (516)524-7693

Membership Type

Annual Membership

$50 • 1 Item Limit

Annual Membership

Lifetime Membership

$350 • 1 Item Limit

Lifetime Membership

Who can we thank for referring you to The Pap Corps? (Soft Credit)

Contact information

What type of membership are you getting?

Pap Member ID (Numeric entries only - Please leave blank if you don't know your ID)

First Name

Last Name

Mobile Number

Address

City

State

Zip

Birthday (Format MM/DD)

How would you like to pay?

This is a secure 256-bit SSL encrypted payment

Card Number

Expiration Date

CVV

I would like to cover the payment processing fee of 3.5%

Donor hereby approves the payment of the charitable donation and/or purchase to Papanicolaou Corps for Cancer Research and in the amount set forth herein.

Membership Type

Contact information

How would you like to pay?

Total amount