Member Options Order Form

Username:
Phone:	(with area code)(no spaces)
Member Option:	Email ($20.00) Email Plus ($40.00) Platinum Member ($60.00) Platinum Member Plus ($70.00)
Email Requested:	@zedr2.com (Leave blank if you want your username as an email address)
Payment Type:	Personal Cheque Money Order PayPal
Mailing Address:	(for billing purposes)
Full Name:
Street:
City:
Postal Code:	(no spaces)
Province:	Manitoba Ontario Quebec Meritimes Saskachewan Alberta British Columbia
Email Address:	(used on the forums)

Your options will be activated as soon as payment is confirmed.