Heels and Rope Membership Mail Order Form
To order Heels and Rope membership by money order or check please make your check payable to Fitness House,
complete the following information, and mail to: (this form can be printed or you can provide the information any way you wish. No membership will be activated until the signed statement below has been received)
Fitness
House Productions
PO Box 501
Astoria, Oregon 97103
Please Check Desired Level of Membership :
_____ 1 year $99.95
_____ 6 months $54.95
_____ 3 months $29.95
Desired:
User Name
___________________
Password _____________________
Read and sign statement:
My signature below certifies that I am an adult, 18 years of age or older, and am lawfully
entitled to receive, access and/or view adult
materials in the community where I live. I understand that I am requesting material of an adult nature. I believe this material to be within the community standards of the area in which I live. I agree to not duplicate materials I
receive or access. I certify that I will not share this material with, or show this material to, any other persons. I certify under penalty of perjury that all of the aforementioned is true and correct to the best of my knowledge.
Signature____________________________________________________________
Print: Name__________________________________________________________
E-Mail Address
______________________________________________________
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