Wild Rose Network
Membership by Mail

Please print out the following form,
attach cash or international money order (NO CHECKS)
and mail it to:

Digital Perceptions
3353 Blvd. des Sources, CP 38047
Dollard-des-Ormeaux, Quebec

Please very the information below. If corrections are necessary, use your Back Button to fix the form.
Website: carolcox.com
First Name: {name}
E-Mail Address: {email}
Desired Username: {username}
Desired Password: {password}

Subscription Length Desired:

Please ensure any money orders are "International" money orders. Thank you.
  Send To Printer