|
Member Name:
_______________________________________________
Member contact information, if different
from/In need of up-date from current info on file:
Street Address:
________________________________________________
City/State/Zip:
_____________________________________________
Phone: ______________________ Fax:
________________________
e-Mail:
__________________________________________
Note: Providing the
above information constitutes permission for Emory Marketing Systems
LLC. to contact member via these means with
updates, special offers and other information.
Credit Card #:
_________________________________
Exp Date: _______________ Zip Code
__________________
Signature of Cardholder:
___________________________________________
Circle
which course you are getting
The
Grappling Nutrition Plan $39.99
Add
Shipping and Handling - $6 in the US- $12 for Foreign orders
|
Yes Lloyd, Count me in.