Complete all Information

 

Name:

 

 

 

His Name:

 

Her Name:

 

E-mail:

 

Telephone:

Street:

 

City:

 

State:

 

Zip:

 

Are you a current Playcouples member?

 Yes         No:

If you answer no,  your card will be charged.

 Renewals: $45.00 New Memberships: $125.00 (includes first party)

Card:

 

Card Number:

 

Exp. Date:

 

Billing Information

Name On Card:

 

Street:

 

City:

 

State:

 

Zip:

 

Copyright 2005  Playcouples Club ..All Rights Reserved

 This site was revised :

Saturday, March 18, 2006 02:07 PM

BJK