Pay for a Membership

For your convenience, you can pay your Membership fees online. Prefer to pay by phone? Call (877) 925-2273.

    • Champion accepts VISA, MasterCard, and Discover credit card payments via our Authorize.Net secure payment gateway.

Membership Payment Form

1. NOTICE: After paying for my membership, I agree to print, complete and mail my Membership Application to Champion EMS 2201 Mobberly Avenue, Longview, TX 75602. My Membership is subject to cancellation if my application is incomplete and/or not sent to Champion for processing. By marking the "I agree" check box, I am indicating that I have read and agree with this statement and the statements printed on Champion's Membership application.

I agree.
I want to:
Apply for a new membership   OR  Renew an existing membership
Member Name:
eg. John Smith
Membership ID:
eg. MBR-12345 or GN0123456-000001
Amount of Payment:
eg. 805.29
Physical Address:
eg. 513 Elm St.
eg. Kilgore
Zip Code:
eg. 75662
Use this address for billing?


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