As soon as you fill out and we process your application below, a membership card will be mailed to you. Please make checks payable to Kettering Health Network and mail to:

Years Ahead Plus+
2110 Leiter Rd.
Miamisburg, OH 45342.

Cost of membership is $10.00 annually. Current year starts from April 1, 2007 - March 31, 2008.

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YOU
First Name:	M.I.:
Last Name:
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Home Phone:
Date of Birth:
Sex: Male   Female

SPOUSE
First Name:	M.I.:
Last Name:
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Sex: Male Female