RUSTY WISE FANCLUB MEMBERSHIP FORM With your paid membership you will recieve ... Individual Membership.......................$10.00 ---------------------------------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 please print clearly Membership Type: 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 |
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