Thank you for visiting our website. If you would like to join BACKSTAGE WITH JON BON JOVI, the only official fan club, fill out this membership application. We'd love to have you as a member. Your One Year Membership Includes: Four informative fan club fanzines with exclusive photos and information about Jon, his music and his band ~ SPECIAL CONCERT FAN CLUB SEATING (where possible) ~ GREAT CONTESTSand other surprises! You also have the opportunity to make FRIENDS OF ALL AGESfrom all over the world through our pen pal section. Of course, there will be Exclusive Fan Club Merchandise  and special Fan Club Trips to see the band.

To Join, fill out the coupon below and mail or FAX (see order form on other side) it to us with your payment ($35.00 U.S. Resident/ $40.00 Foreign Resident). Check, Visa, MasterCard or Money Order in U.S. Funds only Please print clearly.

Send to:   BACKSTAGE WITH JON BON JOVI
                 P.O. Box 326
                 Dept. A
                 Fords, New Jersey 08863

例：山田　花子の場合
NAME(名前)YamadaHanako CIRCLE ONE(性別):    　MALE(男)     　　FEMALE(女)
           　　　(姓)     (名)

例：大阪市山田区花子町１－１－１－１０２なら

STREET ADDRESS(街) １－１－１－１０２      Hanako.Yamada-Ku

CITY (市)Osaka-shi STATE(都道府県) Osaka-Fu ZIP________________←ココは無記入です

DAY PHONE (昼間の連絡先)(       ) ___________ NIGHT PHONE (夜間の連絡先)(      ) ___________ AGE(年齢)___
↑電話番号は未記入でもokです

COUNTRY  (国名)　　JAPAN 　POSTAL CODE(郵便番号)_________________
                       (FOR FOREIGN MEMBERS)

EMAIL  ADDRESS(メールアドレス)_______________@____________________________

Computer print outs of order form acceptable (   )  Check here to be included on pen pal page.
                                 (↑はペンパル募集ページに登録する場合は(　)内にチェックを入れる)

Fax Credit Card Orders Only (732) 738-1277 -  24 Hours Every Day
             (↓はクレジットカードでの支払いを希望する場合は下記に記入する)

(  ) Visa   (  ) Mastercard　←(　)内に使用するカード会社にチェックを入れる

Card Expiration(カード期限):Month(月)　　5月なら   MAY   Year(年)　　2010年なら2010

↑注意！！カードに０５／１０と書いてある場合０５が月で１０が年です！お間違いなく

Card(カード番号)  　　# 1 2 3 4 - 5 6 7 8 - 1 2 3 4 - 5 6 7 8　　←線の上に書く

Cardholder's Signature (サイン)　　X　山田　花子

(↑はカードの裏と同じサインを記入します。漢字なら漢字で)

BACKSTAGE WITH JON BON JOVI the only official fan club, is not affiliated with any other fan club.