Data Entry Clerk

Member Information

Name: RAGAN NUNLEY

Address: *** ******** ***, *********, ** 73098

Phone: 405-***-****

Email: **********@*****.***

Date of Birth: 06-03-1981

Gender: F

General Questions

Consent To Be Contacted

B

Product Information

AWA Plus Silver

$39.99 per Month for Member

Terms and Conditions for AWA Plus Silver

Services & Discount Savings Programs

DirectLabs - Serious medical conditions can go undetected for years without noticeable symptoms. The earlier a problem is detected, the easier and more likely it is to be treatable. DirectLabs® is the leader in direct access laboratory testing and provides access to major clinical labs nationwide. Confidential results are available online in as little as 24 hours for most tests.

Uni Care Dental program- receive savings on dental care expenses that range from 15-50% per visit, on average, at over 226,000 provider locations nationwide. The discount dental program has no exclusions for pre-existing conditions, no benefit maximum, no waiting period, and requires no referrals to see a specialist. Your eyes are the windows to your health. You and your family can see better savings at over 20,000 eye care professionals nationwide, including national chains and local opticians. Association members save on eyeglasses, contact lenses, laser surgery, exams and even designer eyewear. Nurseline The NurseLine benefit is provided for health information only for members experiencing acute symptoms and is not a substitute for regular physical examinations or medical treatment visits and is not meant to replace the customary physician-patient relationship. Callers are encouraged to consult with their physician about any health conditions or concerns. Teladoc™ offers you the convenience of 24/7 access to U.S. board-certified physicians either a phone call or a click away. Physicians can discuss symptoms, recommend treatment options, diagnose many common non-emergency conditions and prescribe medication when medically appropriate. It’s health access at the palm of your hand.

Disclosure: These programs are NOT INSURANCE. They are not a substitute for insurance nor do they qualify under the Affordable Care Act (ACA) or any state mandated provision. You must pay for services at the time they are rendered, and you will receive a discount from participating providers. By signing below, I confirm the following:

You authorize IBS Health Ins on behalf of the AWA to charge the credit card or ACH debit indicated in this authorization. If the above noted payment dates fall on a weekend or holiday, you understand that the payments may be executed on the prior business day. You understand that this authorization will remain in effect until you cancel it in writing, and you agree to notify in writing of any changes in your account information or termination of this authorization at least 15 days prior to the next billing date. This payment authorization is for the type of bill indicated above. You agree to receive text messages to your mobile number regarding your account. Message and data rates may apply. You may reply STOP to disable texts about your account. You certify that you are an authorized user of this credit card or bank account and that you will not dispute the scheduled payments with your Credit Card Company or bank provided the transactions correspond to the terms indicated in this authorization. The monthly membership cost for the AWA Program for a member is ($39.99). The draft will be listed on your statement as IBS Health Ins. Your recurring billing date will be on the same day of every month at your monthly rate and will be drafted from the credit card that you provided to us, each month, unless you call us back to discontinue the service at our toll free number which is 800-***-****. The information I provided is accurate.

I understand the details of the membership including the membership fees. Payment Method

Type: Credit Card

Name: RAGAN NUNLEY

Number: xxxxxxxxxxxx-8350

Expiration: January 2028

Electronic Signature

By electronically acknowledging this authorization, I acknowledge that I have read and agree to the terms and conditions set forth in this agreement.

Signed as Parent / Guardian

Name: Ragan Hines

Date: January 30, 2024 at 2:09:54 PM

IP Address: 99.90.17.128

System: Mozilla/5.0 (iPhone; CPU iPhone OS 17_2 like Mac OS X) AppleWebKit/605.1.15

(KHTML, like Gecko) CriOS/120.0.6099.119 Mobile/15E148 Safari/604.1

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