The Squirrel Lover's Club^TM

Mail In Membership Application Form

The Squirrel Lover's Club

318 W. Fremont Avenue

Elmhurst, IL 60126

The annual membership fee is $28 in the U.S. and $31 outside the U.S.
Three year membership fee is $69 in the U.S and $78 outside the U.S.
Make checks payable, in U.S. funds to Squirrelly Productions.

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First Name:_____________________ Middle Initial:_______

Last Name:____________________________________

Address:___________________________________________

City:_________________________ State:_______ Zip:_______

Country:____________________

Phone Number (including area code):_____________________________(Required)*

Email Address:______________________________

Amount of Payment:____________

How Did You Hear About Our Web Site?:_____________________________

Credit card Number:  __  __  __  __ - __  __  __  __ - __  __  __  __ - __  __  __  __

Expiration Date:  ____/____/____

Signature:__________________________________________________
 
 

*We do not sell or give out phone numbers.