Honorary Membership

Honorary Membership Application

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Additional Member

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Date of Birth

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Drivers License Number

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Full Name

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Business Name

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Street Address

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City

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State

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ZIP Code

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Phone

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Cell Phone

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Membership Levels

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Levels(*)

Diamond $5,000 ($3,000 annual renewal)Platinum $1,000 ($1,000 annual renewal)Gold $500 ($500 annual renewal)Bronze $250 ($250 annual renewal) Invalid Input

Add Device $125 for Bronze or Gold Members (Included with Diamond and Platinum levels) Invalid Input

Defer our cost by checking here to decline your gifts!

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*After Submission please click the Membership Payment button on the next page.

Palm Springs Memorial Foundation
Honorary Program PO Box 1881
Palm Springs, CA 92263-1887 (760) 459-2417