MASUIMI MAX FANCLUB
"Almost Free" Form

click here to print
make sure to include enough postage, a self addressed stamped envelope and at least $10.00
With as little as $10.00 you can get a jam-packed envelope of cool, collectable Masuimi Max memorabillia! The bigger the envelope (SASE), the more stuff you get! Your package may include; signed flyers, photos, posters, tshirts, makeup, horned heart M logo necklaces, horned circle M logo, signed magazines and more!

Masuimi Bad Max
PO BOX 72562
LAS VEGAS, NV 89170

Total Amount Enclosed: _____________________

Your Information

First Name: Last Name:
Address:
Address (cont.):
City/Town:
State/Province: Zip/Postal Code:
Country:
Email: Birthdate:

How many times have you done the almost free special?
- What did you receive last time? (to help prevent sending the same stuff)

 


Are you a member of my site? yes no

If yes, what is your email address?

 

Are you a boy girl

Extra Info (for random drawings)

Shirt Size small med large xl xxl xxxl

Favorite Style:

Hat Size small-med med-large

Favorite Style:

Other Special Request: _______________________________________
(you may not get what you ask for, but what the hell ask anyways)

cash, money order or a certified check
Make all MONEY ORDERS or CERTIFIED CHECKS payable to Masuimi Max.

Note: No personal checks accepted. Payment must be made in U.S. funds drawn on a U.S. bank.

Please sign and date below to certify that you are at least eighteen (18) years of age.

Signature: ______________________________________     Date: ___________________