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
CANADA H9B 1Z0
| 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: |
{sub_length} |
| Please ensure any money orders are "International" money orders. Thank you. | |
| Send To Printer | |