Basic Member Form Please enable JavaScript in your browser to complete this form.First Name, Middle Initial, Last Name *Street Address, City, State, Zip Code *Phone Number *DOB *EmailIf none, please put n/aSpouse - First and Last NameYour spouse will get a membership card as well. Putting "Family" will allow anyone in your family to use the card. Membership Type1 Year Membership ($30)3 Year Membership ($75)5 Year Membership ($125)Lifetime Membership ($250)Credit Card NumberExpiration DateCommentSubmit Helping to meet the health care and economic challenges of all Americans CONTACT US (317)- 915-2500 ara@ara-usa.org RESOURCES About us Benefits Amerilife Agents FOLLOW US
