MEMBERSHIP FORM
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Membership Per Year

Total 

     $300.00

    $300.00

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NOTE: When completing the registration process, please be patient while pages load. If you click the submit button more than once, an account will be created each time and your credit card will be billed accordingly.
 
MEMBER INFORMATION
 
First Name
Last Name
Address
City, State/Province
ZIP/Postal Code      
Phone Number
Fax (optional)
Email Address
 
BILLING INFORMATION
 
This information will be used for billing purposes only.
 
Pay By Credit Card
 
Cardholder Name
Credit Card Number
Expiration Date   
Credit Card Type
Amount ( For details, view the top of the page )
Address
City State/Province
ZIP/Postal Code Country
 
By agreeing, I give Internet Radio Corporation the right to process this order and I
have filled this form to the best of my knowledge. Also, I understand that this order
could not be refund after submitting it.
 

                                

                                

                                
                                I 
                                AGREE

                                

                                Question/Comments:
                                

                                

                                
                                

                                

                                
 
 
                                

                              

                              

                              

                                
                                

                                
                                
            
                                (651) 274-6351 
                                (24 Hour 
                                Service)