*  Last Name: (This is the name of the person you are subscribing for)

*  First Name:

*  E-mail (your e-mail if subscribing for someone else):

*  Your Phone Number (if subscribing for someone else--area code first):

* Address: (of the person you are subscribing for)

 Address Line 2 (optional):

Note: The information you enter in this form is for the person the subscription is going to. When you click "continue to Pay Pal", this information will be automatically transferred to the Pay Pal form (for your convenience if you are subscribing for yourself). If you are subscribing for someone else, just change the information on the Pay Pal form to your billing information. Changing the information on the Pay Pal form DOES NOT change the name and address you entered on the Subscription Form. The information on the Subscription Form is what will go into the data base and that person will receive the subscription.

Please DO NOT USE COMMAS! Please provide a 5 (five) digit zip code only.

*  Subscriber Name:

* Address:

 Address Line 2 (optional):

*  Subscriber Name:

* Address:

 Address Line 2 (optional):

*  Subscriber Name:

* Address:

 Address Line 2 (optional):

*  Subscriber Name:

* Address:

 Address Line 2 (optional):

*  Subscriber Name:

* Address:

 Address Line 2 (optional):

*  Subscriber Name:

* Address:

 Address Line 2 (optional):

*  Subscriber Name:

* Address:

 Address Line 2 (optional):

*  Subscriber Name:

* Address:

 Address Line 2 (optional):

*  Subscriber Name:

* Address:

 Address Line 2 (optional):