Renew Memberships

Last Name*

Husband's First Name*

If applicable

Wife's First Name*

If applicable

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Ohio County*

Home Phone

Cell Phone

Email*

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/dd/yyyy

CHEO 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*

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Renew Memberships

Updated Renewal Membership Application