Membership for Members Only Area
$12.95 per 1 months
$34.94 per 3 months (save $3.90)
$69.95 per 6 months (save $7.75)
Please allow 1 week for activation

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Fan Club (1) - $45.00 (save $15) plus $5.00 shipping
2 personally autographed 8X10's.
1 personally autographed postcard.
2 personally autographed mystique magazine trading cards.

Ultimate Fan Club (2)- $95.00 (save $35) plus $5.00 shipping
ALL THE ABOVE PLUS
1 more personally autographed 8X10.
1 perosnally autographed Playboy or Playboy NSS.
1 Tendy Turner and Roxanne Galla 2000 yellow Ferrari poster.
1 Playboy's "Girls of Mardi Gras" video.

Billing Information

First Name:	Last Name:
Address:
Address 2:
City:
State:	Zip:
Country
Email:	Birthday:

Shipping Information

First Name:	Last Name:
Address:
Address 2:
City:
State:	Zip:
Country

Subtotal	$
Shipping & Handling inside the US = $6.00 Outside the US add additional $10.00
Shipping & Handling	$
California residents add 8.25% sales tax	$
Total	$

print and mail to:
Roxanne Galla Enterprises, Inc.
703 Pier Ave. Suite B-122
Hermosa Beach, CA 90254

Please sign and date below to certify that you are at least 18 years of age!

Signature: ________________________________ Date: __________________

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