SUBSCRIPTION FORM
Route 66 Pulse |
| Mail To: |
Mercury Media Group
Attn: Subscription
Request
140 Main St.
Richfield Springs, NY 13439 |
| Mailing Costs: |
|
For Domestic Subscribers |
|
1 year - $
15.95 |
|
| For International Subscribers |
1 year - $24.95 USD |
|
| NAME___________________________________________________________ |
| ADDRESS________________________________________________________ |
| _________________________________________________________________ |
| PHONE__________________________START DATE____________________ |
| E-MAIL__________________________________________________________ |
|
Please give 2 weeks notification of address changes |