CATHY LEE CROSBY
FAN Club Membership Form
To join, print the following application and submit with your check or money order for $17.95 American Funds for US and Canadian Members, $29.95 American Funds for International fans to Cathy Lee Crosby Fan Club, 1223 Wilshire Boulevard, Suite 404, Santa Monica, CA 90403 USA.

Please Print Clearly

Name: ____________________________________________________________

Address: __________________________________________________________

City: _____________________________________________________________

State ______ Zip /Postal Code ___________________

Country: _________________________

Day Phone: ____ - __________________

Evening Phone: ____ - ________________

Birthday: _________________________

E-mail address: _____________________

Photograph Personally autographed to: ____________________________________________

Please pick the photo you wish to receive:

Please allow 6 weeks for delivery.