Pay Shared Services Network Membership Program InformationName on card(Required) First Last Program Name(Required) Email(Required) Billing Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Payment informationFirst Year Membership Fee(Required) Price: Want to pay for year two today?(Required)Save yourself the headaches and hassles of having to pay for your membership fees in year two by paying ahead. Yes, pay for year two now (adds $3,000) No, pay later Total To Be Charged Credit Card(Required) Cardholder Name Card Details Consent to pay(Required)By checking the above box you are indicating that you understand that submitting this form will result in a charge in the amount previously listed to the card you provided. This charge is non-refundable. I agree to pay electronicallyPhoneThis field is for validation purposes and should be left unchanged.