HeavenleeBound.com
Mail-in Membership Form

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MAILING INFORMATION:
Include your Check or US $ Money Order paying
for the term you wish to join for, and mail to:

Emily Addison
PO Box 273
Mount Holly, NC 28120

Make all checks payable to: Emily Addison

US $ Money Order memberships will be active within 24 hours of receipt of payment.

ALL Personal Checks must clear the bank before your
membership will be activated, this may take up to 14 days.

  
YOUR FULL NAME:__________________________________________________________

STREET ADDRESS:__________________________________________________________

CITY:______________________ STATE:_________________ ZIP CODE:_____________

COUNTRY:________________________________________________________________

PHONE NUMBER:___________________________________________________________

E-MAIL ADDRESS (required):_________________________________________________

TOTAL AMOUNT YOU OWE (In US Currency) $___________________________________

PLEASE CHOOSE THE TYPE OF MEMBERSHIP - ALL ARE NON-RECURRING:

One Month Membership = $24.95

CHOOSE A USER NAME:_____________________________________________________
(up to 8 letters/numbers - this is case sensitive please print if using capital letters)

CHOOSE A PASSWORD:_____________________________________________________
(up to 8 letters/numbers - this is case sensitive please print if using capital letters)

YOUR SIGNATURE: _________________________________________________________
Certifying you are an adult and over 18 years old.