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Register for MP Club
*FIRST NAME
*NAME
Sex
M F
Date Of Birth (DD/MM/YYYY)
*Address
*City
*Zip Code
*Country
*E-mail
Phone
FAX

*THIS INFORMATION IS ABSOLUTELY NECESSARY

If you want to order a record, please mark it here, so that your points can be credited as quickly as possible

MY ORDER IS:

TITLE
PRICE OF ONE (€)
QUANTITY
Blowing A Kiss (CD)
14,90
Theme In Red (CD)
14,90
Parachute (Single)
2,90
Bits and Pieces (MC)
9,90
Kaleidoscope (CD)
11,90
Discovery (CD)
11,90

If you are sponsored by a club member, please complete the following information, so that his or her points can also be credited. MY SPONSOR IS:

FIRST NAME

NAME

MEMBERSHIP NUMBER (IF KNOWN)

 

  
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