Register - BSC Owners Association

Membership Form

All franchisees of the BrightStar Care brand are eligible for membership in the BOA. To apply for membership, please fill out and submit the form and payment below.

Name(Required)

Signatory of the Franchise Agreement

First Last

Initiation Fee Payment Options(Required)

Choose how you’d like to pay your $5,000 Initiation fee. This 10-year membership can be paid in full, annually, or monthly—with no additional fees.

One-Time Payment - $5,000

Annual Payment – $500/year (10 years)

Monthly Payment – $41.67/month (120 months)

One-Time Payment

Price:

Thank you! We're looking forward to meet you!

Annual Payment Recurring

Price:

This is payable within 10 years.

Monthly Payment Recurring

Price:

This is payable within 120 months.

Are you the signatory of the Franchise Agreement?(Required)

Yes

No

Year in which you executed your initial Franchise Agreement?(Required)

Franchisee of Record Primary Email Address(Required)

Franchisee of Record Primary Phone Number(Required)

Partners

Partner First Name

Partner Last Name

Partner's Email

Company Name(Required)

List of your Company DBA

Ex. BrightStar Care of [Location Name]

Company Bill to Address

Street Address Address Line 2 City State ZIP Code

Total Number of Territories(Required)

Personal Email(Required)

Personal Cell Number(Required)

Credit/Debit Card Authorization

By checking this box, you acknowledge and authorize the BOA to charge your credit/debit card for your membership dues — based on your number of territories — as well as the initiation fee deposit, using the credit/debit card information provided below.

If you wish to cancel your membership and remove your card from file, you must email info@bscowners.com to request cancellation.

Please select the box that corresponds to the number of territories you own.(Required)

1 Territory: $500

2 Territories: $575

3 Territories: $650

4+ Territories: $725

Initiation Fee Deposit(Required)

Price:

A one-time initiation fee deposit is required for all members and will be added to your total today.

Please select one option regarding your membership renewal preference.(Required)

Yes, I would like my dues to automatically renew using the payment method provided below.

No, I do not want my dues to automatically renew.

Credit Card

Total

Comment or Message

Username(Required)

Email(Required)

Password(Required)

Enter Password Confirm Password

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