Exit Membership Fee Payment Form Question Title * 1. Member name: Question Title * 2. Email: Question Title * 3. Phone: Question Title * 4. Billing address: Question Title * 5. Select membership level: Level A ($$) Level B ($$) Level C ($$) Question Title * 6. Would you like to make an additional donation? $0 $500 Clear i We adjusted the number you entered based on the slider’s scale. For help setting up payments through SurveyMonkey, please visit https://help.surveymonkey.com/en/surveymonkey/create/accepting-payments/ Done