Collector Registration
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Fill out the form below to become a collector member of Bears&Buds®
Items with * are required |
| *First Name: |
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| Middle Name: |
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| *Last Name: |
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| *Address: |
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| *City: |
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| *State: |
If you do not live in the USA or Canada, enter Region: |
| *Zip/Postal: |
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| *Country: |
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| *Home Phone: |
(xxx-xxx-xxxx) |
| Cell Phone: |
(xxx-xxx-xxxx) |
| *Email Address: |
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| *Select a username: |
(max of 12 characters) |
| *Select a password |
(max of 12 characters) |
| *Re-enter password |
(max of 12 characters) |
| In the event you forget your username or password, we will ask you to
answer a security question. You may select which question to use: |
| *Select a security question: |
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| *Enter your answer to the security question: |
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| *Payment by: |
Subscription fee $20.00
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| If payment is by credit card, please enter the following: |
| Name on Card: |
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| Card Number: |
(please use dashes (-) between number sets) |
| 3-digit security code: |
show me |
| Expiration Date: |
(mmyy) |
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3428 Hillvale Road 