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MEAT LOAF INTERNATIONAL FAN CLUB
APPLICATION FORM

Please print this registration form
and mail with your payment

Meat Loaf International Fan Club
P.O. Box 5248
Bellingham, WA USA 98227

Name: ____________________________ Age: _____________________________ Address: __________________________ City: _____________________________ State/Province: ______________________

Zip/Postal Code: _______________________ Country: ____________________________ Telephone: __________________________ Fax #: ___________________________ Email Address: _________________________

If you would like to use your credit card, please fill out the following information!!! We accept Visa/Mastercard. PLEASE PRINT CLEARLY!!!!!!! Name (on credit card): ___________________________________________ Type of card: ___________________________________________ Card Number: ___________________________________________ Expiration Date: ___________________________________________ Print name of cardholder: ___________________________________________ Signature of cardholder: ___________________________________________

Do you wish to be included in the Pen Pals section and correspond with other Meat Loaf fans? Yes ( ) No ( ) ~*~*~*~*~*~*~*~*~*~*~ Your credit card will be billed to Meat Loaf Fan Club. Please keep a copy of this form to verify with you or your parents' monthly statement.