Karolina Protsenko Fans Club Form

Karolina Protsenko Fans Club Form
Please fill up this form before the deadline and make sure to read the rules of the club.
Registration Date

MonthDayYear
Date
Name

First NameLast Name
Age
Date of Birth

MonthDayYear
Date
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Nationality
Reason for Joining
Google MeetZoomSkypeFacebook MessengerOther
CampingEventsTravelsVirtualOther
Club Package
prevnext( X )
Bronze
Exclusive content 10% discount on merchandise

$250.00



Silver
Exclusive content 30% discount on merchandise Free ticket to 1 event

$380.00



Gold
Exclusive content 50% discount on merchandise Free ticket to 3 events Automatic reservation

$521.00



Total

$0.00
BitcoinPayPalWire TransferCashappPurchase orderGift Cards (accepted)Other
FacebookTwitterInstagramReferralOnline AdsGoogle AdsTV CommercialRadioOther
YesNo
Applicant's Signature

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Date Signed

MonthDayYear
Date
Thank you for joining the club!
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