DizDat.com Mail-in Membership Form
*** CLICK
YOUR BROWSERS PRINT BUTTON TO PRINT THIS FORM ***
Use your BACK button to return to the website
MAILING INFORMATION:
Include your check or money order paying
for the term you wish to join, and mail to:
The DV8 Design Group
C/O Sea Side Media, LLC
6776 105th Street North
Seminole, Florida 33772
Make all checks payable to:
The DV8 Design Group
Money Order memberships will
be active within 24 hours of receipt of payment.
ALL Personal Checks must clear
the bank before your
membership will be activated, this may take up to 14 days.
|
YOUR FULL
NAME:________________________________________________________
STREET ADDRESS:_______________________________________________________
CITY:______________________ STATE:_______________ ZIP CODE:_____________
COUNTRY:______________________________________________________________
PHONE NUMBER:_________________________________________________________
E-MAIL ADDRESS (required):______________________ @ ______________________
TOTAL AMOUNT YOU OWE (In US Currency) $_________________________________
One month = $24.95 - Three months = $59.95
CHOOSE A USER NAME:________________________________
(up to 8 letters/numbers)
CHOOSE A PASSWORD:________________________________
(up to 8 letters/numbers)
YOUR SIGNATURE: ________________________________________________________
Certifying you are an adult and over 18 years old.
|