Well Spouse™ Association
63 West Main Street, Suite H
Freehold, New Jersey 07728
Telephone: 800-838-0879
EIN: 36-3651073
Visit our website

Well Spouse Membership

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Step 1 of 2

Please complete the following to join or renew membership.
Credit cards accepted: Visa, MasterCard, Discover, American Express.

All fields marked with * are required.

Annual membership includes a subscription to Mainstay, all WSA mailings, and participation in regional support groups (where available), workshops, respite weekends, and conferences. Your dues also help underwrite the operating cost of our website, online support forum, and other support programs.

Choose Member Status *
  * When choosing to give a gift membership, choose from the membership option below and then provide gift recipient information on next page
Membership Options *
Cardholder's Name *
Card Number *
type numbers only, no dashes or spaces
Card Verification Code *

(the last 3 digits on the back of your card)
Where is my Card Verification Number?
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Expiration Date: * Month     Year
Don't let your membership expire. Set up Automatic renewal payments!
For your convenience, you may set up recurring renewal payments. Set your initial payment to be made today in the above section and fill out this section for your future payments.
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Billing Cycle  
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or type a specific number
The number of days after today to begin recurring:
Recurring Amount: USD$
Phone Number *
E-mail Address *
Address *
City *
State *
Zipcode *
Country *
Please verify the above information before hitting the Submit button.
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