The Anthony De Longis Fan Club      MEMBERSHIP FORM      (One membership year = four newsletters)      (OR two double issue newsletters)        Noblesse oblige!

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Membership dues are Individuals : $20 (US addresses) or  $22 (Non-US addresses) Family:        $25 (US addresses) or  $27 (Non-US addresses) **Make sure all family members names are listed above when selecting a Family membership Please pay in U.S. Funds, and make checks payable to ADLFC. To pay using PayPal please click on this logo ==>   If using PayPal please fill out this form and send it in for our records.    Mail your check or money order with this form to:        ANTHONY DE LONGIS FAN CLUB       10824 Olson Dr       Ste C  #196       Rancho Cordova, CA  95670 Please allow 2-4 weeks for delivery.                   Form last updated 11/20/04

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