To become a member of the Club, please answer each question as it pertains to you. Be advised that you do not have to disclose a medical condition history, just a medicinal drug history. All members are given a 6 digit ID number, and filed by email address, and mailing address. Method of payment is recorded: check #,MO #, credit card tracking number, and date of the order.

You can print this form for easy ordering upon joining the "Club". You may also complete the form on this page, then copy-paste to an email posting to cornerdrugtexas@hotmail.com. Do not forget the info for any other household family members! This may require several postings.

1. Multiple drug combinations prescribed or recommended for you or family member. Please list all of your current prescription and non-prescription medications, include herbal remedies.. ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

2. List all of your known drug and food allergies: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________

3. List the Herbal supplements you would like to learn more about: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

4. List the Vitamins and mineral supplements you would like to learn more about: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________

5.Submit the following information for each family member:

First Name:_____________________
Last Name____________________
Address:________________________
City, State:____________________
E-mail address:__________________Important
Telephone/Fax______________(optional)

Please include Check #, MO #, Or Credit Card Tracking #.(payment ID number)

All information requested will be provided to members either by e-mail if you include it with your order. Allow 48 hours turn around time for all information requests! Annual MEMBERSHIP FEE : ONLY $10/ Family. (10% of each membership sold is donated to The American Cancer Society)

PROTECT YOUR HEALTH AND WELL-BEING!!

"THE MORE YOU KNOW -- THE BETTER YOU FEEL!"

Payment Options:

    Personal Check

    If payment is made by check, please allow 7-10 days return service.

    Money Order

    Send Payment to:

    The Corner Drugstore of Texas
    185 Terrell Road #601
    San Antonio, Texas 78209

    Print out above form and send along with membership fee. If paying by credit card, copy/paste the form to your e-mail to cornerdrugtexas@hotmail.com, include your card-buy tracking number.

  • Credit Card:


    Your secure payment will be processed by 2CheckOut

    Remember: "The More You Know -- The Better You Feel"!

    15 Ways!>

    Google

    Return HOME, use BACK arrow on browser, or right click BACK on mouse

    ©write 1999-2010 by The Corner Drugstore of Texas