Force Fantasies Membership/Password Order Form
Please print this page (or hand-write a version of it).
Username and password for this membership.  Neatly print:
Username
Password
All letters in your username and password will be lower-case unless you underline each letter that you want capitalized. ~ If you request a Username that is already taken, I will assign a different username to you, and notify you by email.

"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 understand that this membership is for one person only and is non-transferable. I agree that I am solely responsible for protecting my username and password and keeping them completely confidential, known only to myself.  I certify that I will not copy, duplicate, post, upload, share, transmit, email nor snail-mail the material I access or receive via this membership to any other person, website, computer, server, newsgroup, entity, group or company.  I certify under penalty of perjury that all of the aforementioned is true and correct to the best of my knowledge."
Signature
First Name and Last Name.  Neatly print:

MEMBERSHIP PURCHASE

Special offer: 12 months for just $90!

$
(saves you $25)

First month $16
$

 Add up to 7 additional months for $9 each
$                              
add ______ months

TOTAL ENCLOSED
$
When your membership begins, I will send you an email; I will not send you snail-mail.
If you give an incorrect email address, or if I can't read your handwriting clearly, you will not receive notification when your membership starts.

Neatly print: Email address
 (Email address must have one @ and
at least one period in it.)

Make your U.S. money order or U.S. check to "Open Mind Media".
From outside the U.S.A. (outside the United States) pay with international money order.  German money orders accepted only from international banks. 

Mail form and payment to:
Open Mind Media
11024 Balboa Blvd, #727
Granada Hills, CA 91344 U.S.A.

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