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           Membership Subscription Form
  Thank you for your interest in becoming a charter member of Archelan Member Privilege Club. Enjoy all the advantages of membership for only $35 annually. Simply complete and submit the following online form or download a PDF version* of this membership application to begin enjoying your benefits:

* Denotes Required Fields		  
General Information  
Title*
First Name*
Last Name*
Address 1*
Address 2  
Address 3  
Country  
(Limited to USA and Canada only)  
City*
State*
Zip Code*
E-mail Address*
Phone Number  
  Ext. 
Date of Birth (mm/dd/yyyy)*
Payment Information  
Type of Card*
Card Number*
Expiration Date (mm/yyyy)*
 
 
  Privacy Information
We respect your privacy and will do our utmost to protect your personal information. The personal data given on this application will be electronically processed. Your data will be used exclusively for the purposes of enrollment into the Archelan Privilege Membership Club. It will not be used for any other purpose and will not be made available to other companies for commercial use.


* Download Adobe Acrobat Reader.

  
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