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Ground Crew Membership Form


                    
     
                
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                   Dirt Doctor Ground Crew Membership
                                       P.O. Box 140650
                                       Dallas, TX 75214
                              Phone:  866-444-3478 (DIRT)   
                                  Fax:  214 -824-0668
                          

     Membership Request:   qNew       qRenewal       q Gift

Name______________________________________________________

Address___________________________________________________

City_____________________________ State________ Zip___________

Phone_____________________________________________________

Email Address______________________________________________

Please choose a forum name (user name) and password

*Forum name (user name)_____________________________________

*Password_________________________________________________
                          (*User name and password are case sensitive)
Membership Choice:
q 1 year   $24.95     q 2 years $49.90       q 3 years $74.95

q 4 years $99.90     q 5 years $124.75 

 

q My check is enclosed. 
  
q    Please charge my credit card:   qVisa   qMaster Card    qDiscover

Credit Card Number:

 

                             Expiration Number:
                                      
X__________________________________________          _____________                       
                         Card Holder Signature                                    Date
If you choose to join for 2 or more years you will receive
the following gifts.   Please circle T-Shirt size if applicable.
 q 2 Years  Mug

    q    3 Years Mug    or    T-Shirt Size:    S,  M,  L,  XL, XXL

 q 4 years  Mug   and  T -Shirt  Size:   S,  M,  L,  XL, XXL

 q 5 Years Mug    or    T-Shirt Size:     S,  M,  L,  XL, XXL
            and autographed copy of the Dirt Doctor's Bug Book.

           If this is a gift membership please fill out the following:

Gift to:  __________________________________________________

Address_________________________________________________

City_____________________________ State______ Zip__________

Email Address____________________________________________

Phone___________________________________________________

Gift From:________________________________________________

       Thank you joining the Ground Crew and 
                    enjoy your membership.                                  

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