Credit Union Membership Travel Benefits
Order Form

Special Internet Bonus Offer 15 full months' membership for the price of 12
You must use this special Control Number
C186-0

(Please fill in, then print and either fax or mail to us)

Mr/Ms First: I: Last:

Address:

City: ST: Zip -

Daytime Phone ( )

Names to appear on additional membership cards ($9.95 each):

Card one:Card two:

 Annual Membership Dues

$29.95

 Additional Memberships
($9.95 each)

 Select

 Postage & Handling

$2.95

 Total

Basic $32.90
W/one add'l card $42.85
W/two add'l cards $52.80

Select

I'll pay by---

Expires Check Number

 Fax
this form Toll-Free to
(888) 972-0122

 Mail to:
Platinum Membership Benefits Group
P. O. Box 9546
Yakima, WA 98909-9546

 To ensure my benefits don't lapse, please renew my membership when it expires, until I ask you not to. Charge my annual dues to the same credit card I originally joined with. Invoice me if I paid by check, money order or if my credit card is no longer valid. I understand my dues will always be at the low, prefered credit union rate and I may cancel at any time.