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Applicable Subsidiary: Pre-Paid Legal Services, Inc. Pre-Paid Legal Casualty, Inc. CWA FOB FRAN MODE Legal Service Plans of Virginia, Inc. Pre-Paid Legal Services, Inc. of Florida Pre-Paid Legal Access, Inc. PLAN GR# EMPLOYEE BENEFIT MEMBERSHIP APPLICATION Today s Date MM / / DD YYYY A.M. Time of Day P.M. Please Choose the appropriate plan: IDT ST Standard Plan Other Additional Trial Defense GOLD MAS MINORS A $10 non-refundable fee ($25 for CDLP) is.

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