WE LOVE LUCY
MEMBERSHIP
APPLICATION

Please complete the information below, and click on Send Form at the bottom of the page. You will receive a confirmation via e-mail after your application has been processed. If you wish to fax your information, please fill out the form, print it, and fax it to (818) 981-0757. You will still receive an e-mail confirmation.




Name

Address

City State Country

Zip or Postal Code

e-Mail Address

Voice Telephone Number Fax

Please tell us, is this...(check one)

A New Membership
A Renewal


METHOD OF PAYMENT

Dues are $28.00 per year. By providing your credit card information below, you are authorizing We Love Lucy to charge this amount to your credit card.


Please select one:

    Visa
    Mastercard
    American Express
Card No. Exp. Date

IMPORTANT: Please make sure you indicate FOUR (4) sets of numbers for your card number above (3 sets for American Express). We must have complete credit card account information before we can process your application.


Note: If you wish to pay by check or money order, please fill out and print out this page, and mail it to
WE LOVE LUCY, P.O. BOX 56234, SHERMAN OAKS, CA 91413-1234.

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