MEMBERSHIP PLAN AGREEMENTMembership Plan Agreement • September 30th, 2020
This Membership Plan Agreement (this “agreement”) is entered into on (the “enrollment date”), between Cave and Cave Family Dentistry located at 9571 IN-56, French Lick, IN 47432 (“we” or “us”) and (“you” or "Responsible Party") for services provided to (“Member”). Member DOB
MEMBERSHIP PLAN AGREEMENTMembership Plan Agreement • July 24th, 2020
This Membership Plan Agreement (this “agreement”) is entered into on (the “enrollment date”), between Desert Dental – Ryan M. Wieseler, DDS located at 995 W. Orchard Ave., Hermiston, OR 97838 (“we” or “us”) and (“you” or "Responsible Party") for services provided to (“Member”). Member DOB Overview
ContractMembership Plan Agreement • June 27th, 2022
This Membership Plan Agreement (the “Agreement”) is made by and between Constellation NewEnergy, Inc. (“Constellation”) and you the authorized party (“Customer”) (each a “Party” and collectively the “Parties”) as of the date Customer makes payment to Constellation, (“Effective Date”). For good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the Parties intending to be legally bound hereby agree as follows:
MEMBERSHIP PLAN AGREEMENTMembership Plan Agreement • February 2nd, 2023
This Membership Plan Agreement (this “agreement”) is entered into on (the “enrollment date”), between Springs Valley Dental Care located at 9571 IN-56, French Lick, IN 47432 (“we” or “us”) and (“you” or "Responsible Party") for services provided to (“Member”). Member DOB 00/00/0000
PRE-AUTHORIZED DEBIT (PAD) MEMBERSHIP PLAN AGREEMENTMembership Plan Agreement • September 15th, 2022
This authority is to remain in effect until Renfrew Golf Club Ltd has received written notification from me/us of its change or termination. This notification must be received at least thirty (30) business days before the next debit is scheduled at the address provided below. I/We may obtain a sample cancellation form, or more information on my/our right to cancel a PAD Agreement at my/our financial institution or by visiting www.payments.ca
Healthy Smiles Membership Plan AgreementMembership Plan Agreement • January 24th, 2024
Investment Age Service Total Children Enrolling □ Plan 1$320 ≤2 yrs ● 2 Exams● 2 Cleanings*● 2 Emergency Exams● X-rays● Intra-oral photos● 40% off sealants, courtesy repair within first 3 months after placement● 10% off fillings, extractions, crowns, space maintainers (if made in-office), pulpotomy, IPC, silver nitrate, fillings for cosmetic reasons, fillings as a result of dental injury● 20% OFF frenectomy surgery □ Plan 2$374 3 yrs ● Everything in plan 1 plus● 20% OFF nitrous gas □ Plan 3$484 4-12yrs ● Everything in plan 1 plus● Panoramic X-ray● 20% OFF nitrous gas □ Plan 4$506 13-18yrs ● Everything in plan 1 plus● Panoramic X-ray● 20% OFF nitrous gas● 50% OFF whitening tray fabrication + free whitening gel at each visit
MEMBERSHIP PLAN AGREEMENTMembership Plan Agreement • May 9th, 2018 • Missouri
Membership Plan AgreementMembership Plan Agreement • August 19th, 2021
MEMBERSHIP PLAN AGREEMENTMembership Plan Agreement • February 2nd, 2023
This Membership Plan Agreement (this “agreement”) is entered into on (the “enrollment date”), between Springs Valley Dental Care located at 9571 IN-56, French Lick, IN 47432 (“we” or “us”) and (“you” or "Responsible Party") for services provided to (“Member”). Member DOB Overview
MEMBERSHIP PLAN AGREEMENTMembership Plan Agreement • June 5th, 2020
This Membership Plan Agreement (this “Agreement”) is entered into on (the “Enrollment Date”), between Jolyn Su D.D.S. located at 1426 112th Ave NE, Bellevue, WA 98004 (“We” or “Us”) and (“You” or "Responsible Party") for services provided to (“Member”). Member DOB
