ADDRESS: ______________________________ CITY _______________ ST__ Zip ______
PHONE:(H) __________ (W) __________ (FAX) __________ (CELL/PAGER) ___________
EMAIL: ______________________________ WEBPAGE _____________________________
OCCUPATION: ____________________ EMPLOYER: _______________________________
FAVORITE: (Writers) ____________________________________________________________
(Books) _______________________________________________________________________
(Actors) _______________________________________________________________________
(Films) ________________________________________________________________________
*Note: Please indicte your t-shirt size if your purchase is $55 or more. You will recieve BWC T-shirt: ____
CHECK ALL THAT APPLY:
(Prices will increase after April 1st deadline!)
MEMBERS:
___ $150 VIP Gold Member ___ $100 VIP Silver Member ___ $ 55 VIP Bronze Member
___ $20 T-Shirt/ Caps ______ Size: (Add $5 for sizes 2X or above)
MAKE CHECKS PAYABLE TO:
LAWRENCE WAYNE, P.R.
Mailing Address:
Attn: Lawrence Wayne, MBWC
C/o: Ashaun, LLC/
5100 Poplar Ave, Ste. 726 -Plaza Level* Memphis, TN 38137
901-680-2018 off
VIP Gold Membership Benefits: $150
1. Official T-Shirt
2. Official Cap
3. Official Lapel Pin
4. VIP Access To All Events
5. 30% Sales Commission
6. Official VIP Magazine
7. Business card ad (3 issues)
VIP Silver Benefits: $100
1.-4
5. 20% Sales Commission
6. Official VIP Magazine
7. Lising: Name, address, phone (3 issues)
VIP Bronze Benefits: $55
1. Official T-Shirt
2. Official Lapel Pin
3. VIP Access (except banquet or special events)
4. 10% Sales Commission
5. Official VIP Magazine
