APPLICATION
for Membership in SINGLE PARENTS USA!
Code #: __________________________
(Assigned by Single Parents USA)
Please print out this form, fill in the
requested information and mail along with your payment to:
SINGLEPARENTSUSA.COM
3337 WEST FAIRCREST DRIVE, ANAHEIM, CA 92804-3014
Name:
Address:
Phone #H:
Phone #C:
Email Add:
Write in your pass word protected profile listing:
If you wish us to write your profile listing: (Optional but required if you wish
to have access to other member profiles):
Sex __ M __ F Height Ft: __ Inches__ hair color ____ eye color: _____
ethnic background _______________, religion ___________,
Education: __________
Occupation _________, Smoker: __ Y __ No Drinking: __ Y __ N
Interest, Hobbies, Pastimes (What you enjoy):
Please circle the 7 to 10 words that best describe you: romantic liberal conservative carefree quiet marriage-minded
outgoing sensitive intellective affectionate religious
considerate open-minded sense of humor self-confident exciting
serious trusting athletic loyal optimistic sincere emotional
Type of person that you would like to meet:
About your child/children, name(s) age(s), hobbies etc:
Note: I authorize SINGLE PARENTS USA to edit and publish the information contained
herein. SINGLEPARENTSUA.COM cannot guarantee the accuracy of any information supplied by its members. I understand that giving
false information about myself can and may be considered cause for my membership being terminated without refund!
I will not hold SINGLEPARENTSUSA.COM responsible for any dealings between myself
and any person(s) that I contact or
who contacts me through SPUSA.
IMPORTANT NOTICE: All applicants
must meet qualification requirements! SPUSA reserves the right to deny membership to anyone if we believe that to allow membership would not be in the best interest
of SPUSA and/or it's members.
If a member decided to cancel his/her membership before 90 days of full membership SPUSA will give that member a FULL refund. However, if a member is canceled by SPUSA for cause, there will be no refunds made.
We will do all that we can to protect the privacy and well being of our members!
Sign. of Applicant: _____________________________ Date: _______________
Categories of Membership (please select only one)!
Please select your option for membership as follows:
___ Option A:
Family Membership - Single Parents Only With Kid(s)! - Applicant must be either separated, single, divorced or widowed with at least one
child under 18, (Child does not have to be living with you but you must have some responsibility for the child). Benefits
of membership includes access to our monthly newsletter, access to our pass word protected single parent profile listing services,
(Optional), access to all our FREE and or discounted single parent socials and our discounted buying services.
Membership in Single Parents USA is only $20.00 per year; however, you may reduce your annual cost by agreeing to a 3 year,
5 year or 7 year initial membership! See Mbr Options.____ Option B: Family Membership - Single Parents With Adult Kid(s) - Applicant must be either separated, single,
divorced or widowed but is not required to have kids under 18 as in Option A. Benefits of membership includes access
to our monthly newsletter, access to our pass word protected single parent profile listing services, (Optional), access to
all our FREE and or discounted single parent socials and our discounted buying services. Option B Membership in
Single Parents USA is only $29.95 per year; however, you may reduce your annual cost by agreeing to a 3 year, 5 year or 7
year initial membership! See Mbr Options. ____ Option C: Associate Membership! - Associate membership is open to anyone who is supportive of the mission and goals
of Single Parents USA! Benefits of membership includes access to our monthly newsletter, access to all our FREE
and or discounted single parent socials and our discounted buying services. Married couples must join as a family!
Associate Membership is ONLY $40.00 per year; however, you may reduce your annual cost by agreeing to a 3 year, 5 year or
7 year initial membership! See Mbr Options. ____
Option D: Business Supportive Membership! - Business Supportive Membership is open to business owners who are supportive of
the mission and goals of Single parents USA, and are willing to provide 10-50% in profit margin discounts off the products
and services that they offer to members of Single Parents USA, certain exceptions apply. Benefits of membership
includes access to our monthly newsletter, access to all our FREE and or discounted single parent socials and our discounted
buying services. Business Supportive members will be given the opportunity to place a 25 to 30 word advertisement at
this web site! Our Introductory Business Supportive Membership is only $60.00 per year; however, you may reduce
your annual cost by agreeing to a 3 year, 5 year or 7 year initial membership! See Mbr Options.
We accept: __ Visa __ M/C
__ A/E __ Disc & & 3 digit security # on back of card: ____ ____ ____
Card # _______ /_______ / _______ / _________ Exp. date: ______
/______ /_______
Three (3) Diget Security
Cod on Back of Card: _____ _____ _____
Name on Card:
____________________________________________________
Billing address of
card: ______________________________________________
__________________________________________________________________
__________________________________________________________________
SIGN: _______________________________ Date: _______/_______ /_______
Complete billing address of card:
PS: Please provide us with your email address: ________________________________
Please
print out this form, fill in the requested information and mail along with the
your payment to:
SINGLE PARENTSUSA.COM
3337 WEST FAIRCREST
DRIVE, ANAHEIM, CA 92804-3014 - (Map)
Once we have are
confident that you are who you say you are ... we will email you the pass word info to our pass word protected profiles for
all states!
Please email a copy of your completed application to: gospuas@yahoo.com
Welcome Aboard!
SINGLEPARENTSUSA.COM
3337 WEST FAIRCREST DR ANAHEIM, CA 92804-3014 - (Map)
VM: 1-800-844-9639 X 4547 ~ Email:
gospusa@yahoo.com
PS: Please email your application to us as well as sending a hard
copy in the US mail! If you have questions you may use the following form to contact us at: gospusa@yahoo.com
