Thank you for your interest in LifeWise! Please complete the following application, then click Submit. To complete your application, please then click the orange "Pay Membership Fee" button and complete your $20 payment.
Name
Address
City
State
SC
ZIP
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Email
Birthdate
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Jan
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Employment Status
Employed
Retired
Past or Present Occupation
Marital Status
Married
Single
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If married, spouse's name
How did you hear about LifeWise?
Doctor
HealThy Self
SportsClub
Advertising
Website
Health Fair
Church Group
LifeWise
Friend/Family
Well Walkers
All About Seniors
Interests and Hobbies
Exercise
Cooking
Reading/Book Club
Gardening
Hunting/Fishing
Arts & Crafts
Needlework
Photography
Coin/Stamp Collecting
Computers
Woodworking
Card Games
Music
Traveling
Please remember to click the orange "Pay Membership Fee" button after submitting the form to complete your payment and application. Thank you!