If you do not wish to use your credit card on the web, you can print this form and use it to join via FAX. Please review the membership options available to you and simply indicate below which option you want - and the amount. PLEASE include a valid E-mail and/or a phone number we can contact you at if we have any questions.

Name: __________________________


Address: ______________________________

E-mail (Required): __________________________

Card number: ________________________

Expiration Date: ________ CVV2: _______

Card type (Visa or Mastercard): _____________

Please tell us which membership option you'd like: ____________________________________________________________

Notes or special instructions: _____________________________________________________________________________

Username: ______________ Password: ___________________
(Your username may be anything you like, but we cannot guarantee the availability of common usernames, ie. Tom . Your password should be at least eight characters long and should contain both upper and lowercase letters and at least one number.)

My card will be billed as ABCD Webmasters
I understand that these memberships will rebill automatically.

Signature: ___________________________

FAX TO: 413-669-1882