Access Granted Application Web Portal

* Required Field

We will send status on your Application to the email address below

Your Email Address *

Membership Information

Membership Fees

Membership Fees will automatically calculate as you add members.

Tax and Proccessing fee is displayed at the end.

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Your Household

Mailing Address

Address *

City/Town *

State/Province *

Postal Code *

Email *

Primary Phone *

Alternate Phone

Enter the Emergency Contact for your household. Do not enter yourself.

Emergency Contact Name *

Emergency Contact Phone *

Patrons

(press the + to add members of your household)

Be sure to add yourself as a patron.

Patrons

Count: 0

Keep pressing + to add the number of patrons in your family

Membership Fees: $0.00

Terms & Conditions

I certify that the information provided on this application is accurate. *

I agree to Access Granted Systems, LLC Terms & Conditions *

Is there anything else we need to know about your application?

Application Note

Check here if this is your 2nd submission this year.

Payment

Tax: $0.00

Processing Fee: $1.00

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Grand Total: $1.00