Print & Complete this form and send to Address at bottom Your Name   email Address   Postal Address       Program(s)   [ _ ] d'peg! $29.00 [ _ ] Na'Mo! $29.00 [ _ ] X'SqueezeMe! $29.00 [ _ ] M3dia $10.00   Payment Method   [ _ ] - Check / Money Order         Print Cardholder Name and Address on back if different from above   [ _ ] - Credit Card Card Number   Expiration Date   Phone   Signature     Send to Please Contact us for mailing address