Renew Memberships Updated Renewal Membership Application Online Membership Renewal Application Last Name* Husband's First Name* If applicableWife's First Name* If applicableAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Ohio County* Home PhoneCell PhoneEmail* Enter Email Confirm Email Add me to CHEO's E-mail list* Yes No Are you a Support Group Leader* Yes No Are you a member of HSLDA? Yes No Today's Date MM slash DD slash YYYY mm/dd/yyyyCHEO Membership Renewal* One Year Renewal = $25.00 Two Year Renewal= $45.00 Five Year Renewal = $110 Membership Kit Needed?* YES NO Do you need a full Membership Kit mailed to you? If you answer YES, then you will receive your Membership Kit and your membership card. If you answer NO, then you will just receive your membership card.Notice CHEO does not store your credit card number.Credit Card* MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name
