Gold Lifeline Membership Application
Email address *
Lifeline Agent ID Number
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Individual / Organization *
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Type (Individual, Dealer, Insurance Agent, School, Union, etc.) *
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Main Address
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Telephone Number
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Your Name *
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Your Title
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PLEASE EMAIL YOUR DESIRED ART WORK (LOGO, NAME OF BUSINESS/ORGANIZATION, ADDRESS, TELEPHONE # AND ONE LINE OF INFORMATION) KEEP COPY SOMEWHAT LIMITED, TO APPEAR ON KEY TAG OPPOSITE 800 TOLL FREE NUMBER. WE WILL EMAIL YOU A PROOF FOR APPROVAL PRIOR TO PRODUCTION, ALLOW 2-3 WEEKS FOR DELIVERY OF EMERGENCY RIDE KEY TAGS. KEY TAGS VALID FOR ONE FULL YEAR ONCE ACTIVATED BY RECIPIENT. EMAIL ART TO: STUDENTLIFELINE@AOL.COM OR CALL: 800-543-3829 FOR ASSISTANCE. A MINIMUM OF (10) TEN MEMBERSHIPS IS REQUIRED WITH EACH ORDER. RECIPIENTS MAY RENEW PROGRAM THEREAFTER, WE SEND THEM NOTICE OF EXPIRATION AND RENEWAL OPTION.
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