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Text File  |  1994-06-13  |  2KB  |  50 lines
  1.   
  2.                                 CRYSTAL WILDER
  3.                         (Southern Beauties Covergirl)
  4.                        FAN CLUB MEMBERSHIP APPLICATION
  5.               19528 Ventura Blvd., Suite 368, Tarzana, CA 91356
  6.  
  7.  
  8. For a one year membership fee of $ 15.00 you will receive a full color 11 X 17
  9. poster along with the opportunity to purchase items from WILDER'S MERCHANDISE,
  10. at member's only prices, which include:
  11.  
  12.         * CUSTOM XXX RATED VIDEOS DIRECTED BY YOU (15 minutes & up)
  13.  
  14.         * CRYSTAL WILDER T-SHIRTS
  15.  
  16.         * CRYSTAL WILDER PANTIES
  17.  
  18.         * AND MUCH MORE
  19.  
  20.                         PLEASE FILL OUT THE FORM BELOW
  21.                                 (PLEASE PRINT)
  22.  
  23.  
  24. Name: ________________________________________________________________________
  25.  
  26.  
  27. Address: _____________________________________________________________________
  28.  
  29.  
  30. City: _____________________________  State: _________  Country:_______________
  31.  
  32.  
  33. Zip Code: ________________           Birth Date: _____________________________
  34.  
  35.  
  36. Credit Card # (VISA/MC) ___________________________________Exp Date __________
  37.  
  38.  
  39. Hobbies: _____________________________________________________________________
  40.  
  41.  
  42. Interests or Fantasies: ______________________________________________________
  43.  
  44.  
  45.              *** ALL MEMBERS MUST BE AT LEAST 18 YEARS OF AGE ***
  46.  
  47.       VISA / MASTER CARD / CHECKS / MONEY ORDERS / CASH SENT AT OWN RISK
  48.  
  49.                    Please send to the address listed above.
  50.