Complete this form, print out and fax or mail with payment.

Membership Options:

1 month @ $4.95

3 months @ $12.95

6 months @ $19.95

Special Offer! 1 year with free autographed photo @ $29.95 - BEST VALUE!!!

A savings of $149.45

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Check one: Fax | Postal Mail

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I agree to the terms and conditions listed on the web-site. www.midajah.com/account/options.htm

FAX Customers: Complete, print out and fax this form to:
(805) 499-4486

Postal Mail Customers: Send a check or money order along with this completed form to:

FPWN.Com - Midajah membership
PO Box 902
Newbury Park, CA 91320

Please make payments payable to: FPWN

If paying by check or money order, to ensure that your membership does not get cancelled, make sure that we receive your payment 5 days prior to your membership expiration date.