|
|
|
Single |
Family |
||
|
U.S. |
Jev Only |
$9.00 |
N/A |
|
Internet Membership |
$6.00 |
$16.00 |
|
|
|
Full Membership |
$15.00 |
$25.00 |
|
International |
Jev Only |
$15.00 |
N/A |
|
Internet Membership |
$14.00 |
$24.00 |
|
|
|
Full Membership |
$23.00 |
$33.00 |
Amount paid________ New_________
Date paid __________ Renewal______
Name _____________________________________DOB __________
Address _________________________________________________
City __________________________State _____ Zip ______________
Phone Number(s)
Home (____)___________________ E-mail _____________________
Family Members (include separate phone numbers, if applicable)
|
Name |
|
Birthdate |
Make checks payable to: Victor Manuel
Send dues, accompanied by this completed form to:
Intergalactic Klingon Empire
1009 Bedford Ct. W.
Hurst, TX 76053
