1345 Encinitas Blvd. E-125. Encinitas, CA 92024. Bus. 760-688-9819. Fax. 760-652-4807

(1) I________________________________ agree to purchase My Family Emergency Services   Emergency Membership Program. (2) I agree to give M.F.E.S permission contact the three people I have chosen to be contacted if I am unable to speak for myself or able to contact them. M.F.E.S. may give Law enforcement personnel, and rescue personnel, if I am faced with an emergency. (3) I give M.F.E.S., and any of its associate’s permission to notify my family and friends whom I have chosen to be notified if I am faced with an emergency. (4) I fully understand that M.F.E.S. notification hot line is not a quick respond emergency hotline, and used only to receive call from emergency personnel, and notify my relatives and friends within 72 hours. (5) I agree not to hold M.F.E.S. legally responsible for any false or misleading information given by me or any of my relatives joining M.F.E.S. emergency membership program. (6) I agree if I do not cancel my membership at the end of my membership period, M.F.E.S. will automatically renew, and billed to me each year.  I agree any cancellation must be done in writing. (7) I agree to contact M.F.E.S. within seven days of any chances to addresses, telephone numbers, and medical conditions, for any relatives I sponsor and myself on M.F.E.S. membership program. (8) I agree to provide M.F.E.S. with a recent photo of each family member on this membership program. (9) I agree and understand that I can cancel my membership at any time without cause, and refunds will be prorated by the number of months I was a member. (10) I understand and agree that M.F.E.S. main mission is to provide emergency ID cards, ID tags, and to notify my relatives and friends if I am faced with an emergency. (11) I acknowledge this is a legal agreement between M.F.E.S. and me. (12) I agree that I am in my right mind, and have the capability to enter this agreement.
Disaster Membership program
Membership Fee                     
1. Adults         $35.00 
Address:________________________________________________City:____________________St:______ Zip:_______________
Home Tel: ______________________________________________Bus:____________________Cell:________________________
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Membership form

Parent's or Guardian's Name
Associate's Name