NESSAholics.com Membership Form
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*Note: Fields with an asterisk are required.
*First Name
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Last Name
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City
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*State/Province
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*Zip Code
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*Country
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*Email Address
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*Birth Date
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Forum SN
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AIM SN
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MSN SN
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ICQ SN
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Yahoo SN
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Favorite Vanessa Song:
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Number of Vanessa Shows Attended:
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Would you like to receive updates from NESSAholics.com/A Thousand Roses.org?
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Are you willing to volunteer your time?
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Are you willing to donate money?
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Are you willing to travel?
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Would you like to be a part of the NESSAholics.com/A Thousand Roses.org leadership?
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Would you like to be contacted concerning contests or street team info?
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Have you signed up for Vanessa's Official Street Team?
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Make my information public
Do you have any skills? (IE. Fundraising, web design, talents, etc.):
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Do you have a suggestion for an A Thousand Roses or NESSAholics.com project?:
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Do you have any other comments?:
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