Membership Registration Form

To join, please fill out and submit the form below. Or print the PDF version of the Registration Form, and mail it to us, along with a cheque for the correct amount to:

Grunge Texture Reference, 1232 Wilkinson Road, Comox, British Columbia, Canada, V9M 4B8

Part A: Membership
preferred user name:
user password:
verify password:
type of membership:	12 month membership for $180 6 month membership for $96 3 month membership for $54 1 month membership for $20 * all costs are in Canadian Currency.
Part B: Contact Information
last name:
given names:
e-mail address:
address:
city:
state / province:
country:
phone number:
comments/suggestions:
Part C: Agreement
	I have read and agree to abide by the grungeTextureReference.com’s Terms of Membership and Use.