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Quality of Life Card Activate Your Card

Fill out this form and click the "Activate" button at the bottom of this page to get started.


Your Name
We need your name, both first and last.

Your First Name:

Your Last Name:



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Your Card
Please enter your Quality of Life card number once, and then again. This helps ensure that you enter the correct number.

Your Quality Of Life Card Number*:

*NOTE: Please make sure that you enter your number beginning with the little number "4" that is next to the main number.

Please re-enter your Quality Of Life Card Number:


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Contact Info
Now we need your address information.

Your Address:

Building, Apartment No, etc.:

Your City:

Your State:

Your Zip Code:

Your Phone Number:
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Your Email Address**:

**NOTE: Your email address is required for retrieving your password should you forget it.

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Your Access
You'll need a password to access many of our Quality of Life card features. Enter your password here, and then re-enter your password to insure that you have entered it correctly.

Enter a password:
(Maximum 8 characters)

Re-enter your password:



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Almost Done!
Just click the "Activate" button to submit your registration.





 
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