Join Us at Diva Registry

Join Us

Membership Application

(All information is kept strictly confidential)


Membeship Status :
First Name :
Last Name :
Image:
Requested Diva Name :		(1st Choice)
Requested Diva Name :		(2nd Choice)
Requested Diva Name :		(3rd Choice)
Email :
URL:		(http://www.test.com/)
Address :
City :
State :
Zip :
Requested Special Diva Registry Num:
Date Registered Diva Viva La Diva Fest :
City Registered Diva: Viva La Diva Fest:
Credit card info :
			OR
Mail check to: P.O. Box 177, Wildomar CA 92595

Membership Terms:
		Annual : $35
		Life-Time Membership - $199
		Special Registry Number $7.00 per year/ $35 per Lifetime
		3-yr Membership - $90
	Credit card transaction fee: $5

Login Info:
Login:
Password: