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Membership Application

Published on 5 days ago | Categories: Documents | Downloads: 1 | Comments: 0

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Content

 

Membership Membersh ip Application

 

NAME:  Last 

 

First

Middle Initial 

ADDRESS:

CITY:

STATE:

ZIP:

PHONE:

COUNTRY:

EMAIL:

  MEMBERSHIP NUMBER (if you have one)

/

BIRTHDAY:  Month

/ Day

GENDER: (circle one)

FEMALE 

MALE

Year 

(WE DO NOT SHARE OR SELL PERSONAL INFORMATION)

  Membership Level:

*

 Please circle T-SHIRT SIZE *

(check one box ONLY)

US Residents Only: 

Outside US (Including Canada):

US Premier ($45.00 USD) 

International Premier ($60.00 USD)

OSFA

M

L

XL

XXL

Babydoll California residents add sales tax (48.93 USD)   US Premier Plus ($55.00 USD)

Please allow 8-10 weeks for delivery

  California residents add sales tax ($59.81 USD)

PAYMENT TYPE (circle one):

CHECK

I enclose a check or money order number:

MONEY ORDER

CREDIT CARD

In the amount of

(IN USD ONLY)

Please make checks or money orders payable to The Metallica Club. If you choose to pay for your order with a check, you must allow 3 weeks for the check to clear before your order is processed. We accept checks in U.S. dollars from a U.S. bank ONLY. To our friends outside of the  USA: We accept checks or money orders in U.S. dollars only if your local bank is affiliated with a U.S. bank.. Otherwise, you may want to consider a credit card payment or traveler’s checks. We do not accept money transfers. transfers. We do not accept checks in any foreign currencies. Please do not s send end cash.

I request that you enter me as a member of The Metallica Club Cl ub and send my membership package to the t he address stated above. Signature

CARD HOLDERS DETAILS:

CARD #:    NAME:

Date The CVV2 code is the 3 digit code on the back of MasterCard, VISA & Discover or the 4 digit code on the front of an AMEX card

IMPORTANT

EXP: (MM/YE (MM/YEAR) AR)

CVV2 code

BILLING ADDRESS (if different than above) :

CITY/STATE/ZIP/COUNTRY: AMOUNT: $

(IN US DOLLARS)

Don’t forget to add sales tax if you live in California.

I hereby authorize THE METALLICA CLUB to charge the above amount to my credit card as detailed above. SIGNED: Please send your application to: The Metallica Club, PMB 194, 369-B Third Street San Rafael, CA 94901-3581

DATE: Or you may fax it to: 415-458-1752

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