RUSTY WISE FANCLUB MEMBERSHIP FORM With your paid membership you will recieve ... NewsLetter Postcards Pictures Membership card / certificate & much, much more Individual Membership.......................$10.00 Family Membership...........................$15.00 ---------------------------------cut here------------------------------------- print this page, and return this portion with your check or money order (For VISA / MasterCard), Call 1-888-396-0636 To:   RUSTY WISE FAN CLUB         PO Box 1122         Cherryville, N.C. 28021         please print clearly Membership Type: New__________Renewal_______Family______(Limit of 4) Member's Name_______________________________________________ Street Address________________________________________________ City____________________________State_______________Zip_______ Home Phone (________)__________________________________________ If this is a family membership, list the names of the family members other than yourself: 1._________________________________ 2.____________________________ 3._______________________________________________________________ ---------------------------------cut here------------------------------------- Please allow 3 to 4 weeks for delivery of Fan Club Material                thank you!

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