I authorize Partida Corona Medical Center to automatically draw the re-occurring payments for a 6-month commitment from the enrollment date with the monthly membership fee of $150.00. This commitment will automatically continue on a month to month basis until a written letter asking for cancellation is submitted in writing via e-mail to support@partidacorona.com. 

Terms and conditions are of a six month commitment starting from the date this form is signed and submitted. Credit card processing fees are not included in the amount above and will be charged additionally to the member each month.