Maci Wainwright Fan Club

Membership Application

PO Box 950

Bethany, OK 73008

Name:_______________________________

Address:_____________________________

City:___________ State:____ Zip Code:_____

Phone____________ Phone #2___________

Email________________________________

Birthday:_________ Anniversary:__________

Mail Preference ___Email ___ US Post office

www.maciwainwright.com

For Official Use Only