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

ZIP

Phone Number (enter numbers only, no dashes)

Birthdate

Employment Status

Past or Present Occupation

Marital Status

If married, spouse's name

Please remember to click the orange "Pay Membership Fee" button after submitting the form to complete your payment and application. Thank you!