Membership Signup | demo.circle-interactive.co.uk

This membership signup form has been created using a CiviCRM contribution page.

It allows users to select a membership type, enter their personal details and make an online payment.

Upon submission of this form, a new contact is created in CiviCRM with a membership and linked contribution.

Use these test card details to complete the form:

4444 3333 2222 1111 | Sec Code: any three digits | Exp: Any date in the future

Membership *

Bronze - £ 50.00 (includes VAT of £ 0.00)

Silver - £ 100.00 (includes VAT of £ 0.00)

Gold - £ 150.00 (includes VAT of £ 0.00)

Platinum - £ 350.00 (includes VAT of £ 0.00)

Please renew my membership automatically.

Total Amount

Name and Address

First Name *

Last Name *

Email *

Street Address

City

Postal Code

Phone No.

Credit Card

Card Type

Card Number *

Security Code *

Expiration Date *

My billing address is the same as above

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

County *

Postal Code *

Membership Details

Would you like to appear in our Membership Directory? *

Yes No

Would you like to display your email address on the directory? *

Yes No

Would you like to display your phone number on the directory? *

Yes No

Bio for the member directory *

Upload a photo for the Membership Directory?

Provided as a free CiviCRM demo by Circle Interactive. This site refreshes overnight and may be updated by anyone in the meantime. Please report any problems.

Company Number: 05540067 - Registered address: 1 Osborne Rd, Bristol BS3 1PR - ICO Registration Number: ZA208924