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 Membership request from 


Mail to:

 AuthorsDen.com
 PO Box 339
 Ramona, CA 92065
 Phone: 619-270-1212
 


Order Number:
9
 Method of Payment
Check
Make Check or Money Order payable to: "AuthorsDen.com"
Credit Card
Type:
Mastercard
Visa
AMEX
Discover
Credit Card Number: _______________________________
Exp. Date:
___/______
Billing Address:
_________________________________________
_________________________________________
Telephones:
Daytime:
(____) ___________________
Evening:
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 Annual Membership Plans
Quantity
  Description
 
1-Year
(Credit Card or Checks)
______
Annual Bronze Membership Plan
  $ 75.00
______
Annual Silver Membership Plan  
  $ 120.00
______
Annual Gold Membership Plan
  $ 210.00
______
Annual Platinum Membership Plan
  $ 840.00
Total:
$________

Special Instructions:_________________________________________________

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