APPLICATION FORM

NAME:_______________________________________________

ADDRESS_____________________________________________

____________________________________________________

PHONE NO. __________________________________________

E-MAIL ADDRESS _____________________________________

NEW MEMBERSHIP___________ RENEWAL ____________

AMOUNT ENCLOSED $__________________________________

METHOD OF PAYMENT: ______CHECK_______ MONEY ORDER.........

Mail to:

The Official Michael Peterson Fan Club

P.O. Box 22124

Nashville TN 37202

New Membership: $20.00 USA/Canada and $25.00 International, US FUNDS ONLY.

Renewals: $15.00 USA/Canada and $20.00 International