When filling out this form, please print neatly. The only required information is your name.
Send this form with a $15 check made out to Brad Anderson to:
Brad Anderson
917 Merion Square Road
Gladwyne, PA 19035-1509
USA
If you don't have access to an United State bank account, send $15 in cash in an opaque envelope.
As soon as I get this letter, I will enter your name into my black box. The black box will spit out a serial number which I will e-mail to you OR mail to you if you don't have an e-mail address. This black box will also send you notices of updates when they come out.
Your Name:
Address:
E-Mail Address:
(If you have more than one, enter your primary address)