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Membership & Order Form

(Please print the form first, and then fill it out.)

Date:

YES, I want to be a member of OrganicNation.

Please find enclosed my personal check, certified check, or money order for $20 (or equivalent in the currency of your country), made out to the order of OrganicNation/drexel (if you are sending a money order, please specify an International Postal Money Order if you are outside of the U.S.A.).

First Name

Last Name

Address

City

Country

E-mail address

Day phone

Evening phone

I understand that you will e-mail my username and password to confirm this membership as soon as you receive this order (unless I am paying by personal check, in which case there may be a delay of up to 1 - 3 weeks).

We also accept Paypal, offering payment with most major credit/debit cards. Please follow the instructions carefully.

By acting now, I also get the Lifetime Upgrade Membership Package, FREE.