
Your Information
Type of Membership:	The '80s Server -- Music Fan Clubs
Duration of Membership:	One Month ($4.95) One Year ($39.95, 11 cents a day!)
First Name:
Middle Initial:
Last Name:
Street Address:
Apt/Suite #:
City:
State (U.S. only):
Province (Canada only):
Country:
Zip/Postal Code:
Day Phone:
Home Phone:
E-mail Address:

Giftee's Information
First Name:
Middle Initial:
Last Name:
E-Mail Address :
Phone :
Do you want the free mousepad? Yes -- No
When would you like us to contact the recipient:

Payment Information

PAYMENT METHOD: Credit Card -- Check or Money Order

IF CREDIT CARD:

Type of card:

Card Number:

- - -

Expiration Date:

IF CHECK OR MONEY ORDER:

Make check payable to:
The '80s Server

Or MusicFanClubs

Send payment to:
The '80s Server
Or MusicFanClubs

8650 College Blvd. Suite 111
Overland Park, KS 66210

Your account will be activated upon receipt of payment.

Have questions? Need help? E-mail us!