Henecia Downunder Fan Club Registration Form

Henecia Downunder Membership Form
Please fill in this form and send.
You can go back into it and edit the application at anytime.
Payment must be received for membersip to be processed.
Registration Date

MonthDayYear
Date
Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
How did you hear about us?

FacebookTwitterInstagramWord of Mouth/RecommendedOther
If you wish to join our chat group on FB - please email Here

Thank you for joining the club!
________________________________
PAYMENT

Easily pay your Membership / Donation here Pay here (PayPal.Me link)

$20 / year

Please make sure the amount is sent as a Gift to
our email: admin @heneciadownunder.au

If you don't have Paypal. You can pay using bank transfer and
ID fortylove@optusnet.com.au

We look forward to many more fun activities and projects

Thank you so much for joining us

Please note - going back into the Membership creates another form. If you have made a mistakeo on your form, please email us
admin@heneciadownunder.au
Address*

CityState

Zip CodeCountry
Email
admin@heneciadownunder.au
Should be Empty:

We look forward to many more fun activities and projects Thank you so much for joining usPlease note - going back into the Membership creates another form. If you have made a mistakeo on your form, please email us admin@heneciadownunder.au