APPLICATION FOR MEMBERSHIP ========================== **ALL FIELDS ARE REQUIRED** Applicant's Name: _________________________________________ Applicant's Address: _________________________________________ _________________________________________ Applicant's City: _________________________________________ Applicant's State/Zip: _________________________________________ Applicant's E-Mail: _________________________________________ Proposed Username: _________________________________________ Proposed Password: _________________________________________ * Private Membership:Payment Enclosed: ()$57.95-one year Membership or ()$24.95-90 day Membership (check one) * Commercial Membership:Payment Enclosed: ()$98.95-one year Membership ========================================= I'd like to see your Site improved in the following way (optional): ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ Please allow two weeks minimum for processing. You'll be notified by e-mail. Mail to: The Vitalsearch Company Worldewide, Inc. Classic Video Streams Department 4000 Pimlico Drive; Suite 114 Box 143 Pleasanton, CA. 94588-3485