MEMBERSHIP FOR WWW.DESIREEELLIS.COM

Please print and mail your completed form along with your payment to:

Desiree Ellis
PO Box #45
1195 Davie St.
Vancouver, BC
V6E 1N2
CANADA

desiree@desireeellis.com

NAME:____________________________________________________________

ADDRESS:_________________________________________________________

CITY/STATE_______________________________________________________

ZIP CODE:__________________________COUNTRY:____________________

Select length of Membership:

______ 1 month membership: $24.95 _____ 3 month membership: $74.85

______ 6 month membership: $149.70 ____ 12 month membership $299.40

Select Payment Method (US funds only). Make payable to "Desiree Ellis"

Cash ______ Money Order ________-International US funds only

E-Mail address: ________________________________________________

Your membership user name and password access information is for your use only. Our system has a special security protection that will detect anyone who has given, posted or traded his or her access information and immediately lock the violators out of our system. Please do not share your information with anyone!