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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
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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
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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.
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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:________________________________________________
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Thank you joining the Ground Crew and
enjoy your membership.
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