I.B.M. RING 17

ON-LINE MEMBER INFORMATION APPLICATION FORM

PLEASE FILL OUT THE FOLLOWING INFORMATION AND PRESS SUBMIT BUTTON

INTERNATIONAL BROTHERHOOD OF MAGICIANS MEMBER NUMBER

FIRST AND LAST NAME

COMPANY

ADDRESS

CITY

PROVINCE

POSTAL CODE

TELEPHONE NUMBER

E-MAIL ADDRESS

WHICH OF THE FOLLOWING WOULD BEST DESCRIBE YOUR PRESENT STATUS IN MAGIC?

HOW LONG HAVE YOU BEEN INTERESTED IN MAGIC?

DESCRIBE YOUR BACKGROUND/INTEREST IN MAGIC

HOW DID YOU HEAR ABOUT I.B.M. RING 17?

SPONSORS NAMES:

#1

#2

E-mail Ring President

Bob Taylor

E-mail WebMaster

A.W. Hobson

FULL TIME PROFESSIONAL

PART-TIME PROFESSIONAL

AMATEUR

BEGINNER

COLLECTOR

LESS THAN 2 YEARS

2 TO 5 YEARS

5 TO 10 YEARS

10 TO 25 YEARS

25+ YEARS