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Become a Member Here!

Here is the text at the top of my page.
First Name:
Last Name:
Title (optional):
Organization (optional):
Address:
City:
State:
(ignore for non-US transactions)
Zip Code:
Country:
Email Address:
Confirm Email Address:
Preferred Phone:
Credit Card Billing Address
 
 If the address where you receive the credit card bill is different than above, please enter it here.
Address:
City:
State:
Zip Code:
 

shirt size
hat size 7 8 9 10 11
shoe color blue green yellow red orange
what clothes do you like?
Here is my pricing text.
Member level ($30.00) - Here is the member level info.
Silver member ($50.00) - here is the silver member. you can be really cool with this!
senior member ($0.00) - free, because old is good!
Charge Amount:
Pay by Credit Card  
Card Type:
Credit Card Number:
Credit Card Expiration (mm/yy): /
Name On Card:
C V V Value:
 
Here is my bottom text.