Mail In Order Form

Name:                                                                                            
Street:
City
State
zip code:		  
E-Mail address:                                                                                               
Log-in name:
Password:
2 year membership                                                                                        $30.00  
1 year membership                                                                                        $20.00 $            
6 Months                                                                                                        $15.00 $        
3 Months                                                                                                        $10.50 $              
1 Month                                                                                                            $7.00 $            
Total for Order $              

Send order to with payment in Check or money order Note: payment is to be made in US funds.:

Mary Blake

92 Taftville Occum Rd.

Norwich, CT. 06360

Please print two copies and keep one for your records. E-mail your order for faster delivery. Please include all information so I can process your order quickly and accurately.