New Member referred by 12283

 

 

NAME:

 

                                                                Last                                                                         First                                                 Middle Initial

ADDRESS:

 

 

CITY:                                                               STATE:                  ZIP:                                           COUNTRY:

 

 

PHONE:                                                                                                   EMAIL:

                                                                              

BIRTHDAY:                                  /                                      /                                                           GENDER:  (circle one)              MALE                FEMALE                                                                                                                    

                             Month                         Day                             Year                                                                                                                                                                                                                                                                            

 

(WE DO NOT SHARE OR SELL PERSONAL INFORMATION)

 

Membership Level:  (check one box ONLY)   US Residents Only:                                                       __ US Premier  ($45.00 USD)                                                                                            __ US Premier Plus   ($55.00 USD)   Outside US (Including Canada): __ International Premier  ($60.00 USD)

Please circle T-SHIRT SIZE *         OSFA     M     L     XL     XXL        (Babydoll)   Please allow 8-10 weeks for delivery

 

           

                                                                               

PAYMENT TYPE (circle one):                          CHECK  MONEY ORDER CREDIT CARD

 

I enclose a check or money order number:                                                      In the amount of                                  .00 (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.  We suggest that you contact your local bank for further information about international bank drafts, “swift checks”, or money orders used for U.S. dollar transactions. Otherwise, you may want to consider a credit card payment or traveler’s checks. We do not accept money transfers.  We do not accept checks in any foreign currencies.  Please do not send cash.  Always include payment with your application.

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

                                                                                                                                                                                                                                                                                                  

Signature                                                                                                              Date                                                                                                                                                            

CARD HOLDERS DETAILS:                                                                                                                     IMPORTANT!                                                                                                    

CARD #:                                                                                                                                   EXP: (MM/YEAR)

 

NAME:                                                                                                                  

 

BILLING ADDRESS (if different than above):

 

 

CITY/STATE/ZIP/COUNTRY:

                   AMOUNT:  $                            .00 (IN US DOLLARS)                                                                                  

                                                                                                                                                                               

I hereby authorize THE METALLICA CLUB to charge the above amount to my credit card as detailed above.

 

SIGNED:                                                                                                                                             DATE:                                               

 

Please send your application to: The Metallica Club,                                      Or you may fax it to: 415-458-1752

                                                    PMB 194, 369-B Third Street

                                                    San Rafael, CA 94901-3581