Please print this form and mail to:

OFFICIAL CHRIS DEMETRAL FAN CLUB 
P.O. Box 55834
Sherman Oaks, CA  91413

Name  ____________________________________________

Address  __________________________________________

    ________________________________________________

    ________________________________________________

    ________________________________________________

    ________________________________________________

    ________________________________________________

Phone  ____________________________________________

Birthday (optional)  __________________________________

Email address  ______________________________________

To use the Member's Only portion of the site, you will need to pick a user name and password.
The password should be at least six characters long and cannot match your user name.
Please print legibly!

User name  ______________________________________

Password  ______________________________________

USA $ 20.00
Europe & South America & Africa $ 28.00
Canada & Mexico $ 25.00
Far East & Pacific $ 33.00

Total Remitted $____________________

Make checks payable to CHRIS DEMETRAL

Please send a Self Addressed, Stamped Envelope (SASE) in order to be mailed a receipt.

(All membership dues are used to cover printing and mailing costs.)