|
Type your
name and e-mail address into the boxes provided and check the
appropriate buttons. Then print out this form (or write out everything
shown here on a clean sheet of paper) and sign and date the form.
All information will be kept STRICTLY confidential.
By signing
up as a member, you agree to abide by the rules of the Clitical
Gold Membership Agreement. As stated in the Agreement,
you wish to receive a Clitical Gold Mebership login combination
via e-mail and understand your membership may be revoked if you
abuse Clitical Gold or reveal a Clitical Gold Membership login
combination to a non-member. If you want to terminate your membership,
just let us know
but understand that if you change your mind you'll have
to re-apply for membership. You also agree when signing this form
that you are over the age of 18.
Signature: Today's
date:
For a 6-month
membership, send the form along with $39.95 ( money order payable
to Clitical. US funds only please); For a 12-month membership,
send $59.50; Mail the form and payment to:
Clitical.
2700 W. College Avenue,
PMB #288,
Appleton WI 54914
Please fold
this form around your payment. Thank you very much, and enjoy
your Clitical Gold membership!
Please keep
a copy of this form for your records.
Back
to Clitical.Com
|