DragonLily.net | Join by Mail Form

DragonLily.net | JOIN BY MAIL FORM

To join by mail you must fill this form out completely(all areas are required). Sign the line verifying your age. Then mail both this form along with a money order or concealed cash to the address below. You will receive a confirmation email when this signed form and payment have been received which will include your membership details including your unique alphanumeric case sensitive username and password.

First Name:______________________

Last Name:_______________________

Date of Birth:_____________________

Phone: __________________________

Address:

City :___________________________

State: ___________________________

Zip: ____________________________

Country: _________________________

email: _________________________________________________________________

By signing below, I certify that I am at least 18 years of age, it is legal to view adult content and XXX rated materials where I live and that I was born on the date of birth entered above.

Signature:

____________________________

Date:

_____________________________

QTY	Description	Price	Total
	30 Day Membership	$24.95
	90 Day Membership	$59.95
	180 Day Membership	$99.95
		TOTAL DUE:

Money Orders payable to:

Kelley Maren

Mailing Address:

DL Media
c/o Kelley Maren
2657 Windmill Parkway Suite #148
Henderson, NV 89074