The Official Rick Alviti Fanclub Application Form

Rick Alviti Fan Club
c/o L. Wilkes
102 Quinby Street
Summerville, S.C.29483
Phone : 843-873-5632

Fan Club Application

Name(s):______________________________________________________

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Address:______________________________________________________

City, State, Zip:_________________________________________________

Phone#:_(__)_____________ E-mail:_______________________________

Birthday(s) Of Member(s) (Optional)

Name________________________Month___________Day_____________

Type of Application: ______New ______Renewal

Annual_______Individual ($15.00) ______ Family ($22.50 - same household)

Payable to Rick Alviti Fan Club. U.S. Funds - Outside U.S. add $10.00

Comments or Suggestions_________________________________________

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