WDIFL Membership Mail-In Order
Form
Print Out -
Fill Out - Mail In (US Funds Only)
Please sign me up for WDIFL Membership:
One Year Membership @ $75.00 per year
Life Time Membership @ $200.00
Total: ________________
______________________________________________
Name: ___________________________________________________________
Address: _________________________________________________________
City: _____________________________________________________________
State: _______________________________________ Zip Code: ____________
Mailing Address (if different): __________________________________________
Phone (Days): ____________________ Phone (Eves): _____________________
e-mail Address: ______________________@_____________________________
Choose your Username and Password must be at least 6 characters long and are case sensitive.
Username: _____________________________
Password: ______________________________
Select Payment Type: (include payment with form)
Check Payment Type: _____Cashiers _____ Money Order _____
Certified Check
_____ Personal Check
Credit Card Payment Type: _____ Visa _____ Mastercard
Name as it appears on card: ___________________________________________
Card Number: _______________________________________________________
Expiration Date: _____________________________________________________
Your Signature: ______________________________________________________
Make checks payable to: Don
Ewald
Mail Order Form To:
Don Ewald
5400 SE 4th St
Del City, OK 73115
E-mail: Membership Desk