Individual

Name:*

First Name Required Last Name Required

Address Line 1:* Address Line 1 is Required

Address Line 2: Address Line 2 is not valid

City:* City is Required

Country:* Country is Required

State/Province:* State/Province is Required

Zip/Postal Code:* Zip/Postal Code is Required

Number for text notifications (optional): Number for text notifications (optional) is not valid

Birthdate (optional): Birthdate (optional) is not valid

How did you hear about the Cafe?: How did you hear about the Cafe? is not valid

Username:* Invalid Username

Email:* Invalid Email

Password:* Invalid Password

Password Confirmation:* Password Confirmation Doesn't Match

Password Strength

Stripe

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Pay Food & Mood with Amy

$19.95 / Month

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Terms: $19.95 / Month

	Individual – Initial Payment $19.95 / Month	$19.95
	Total	$19.95

Individual – Initial Payment

$19.95 / Month

$19.95

Total

$19.95