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SHIPPING ADDRESS INFO
Membership Type *	The Peoples Front of Judea ($30.00) Official Fan Club for Ben Folds (1 year membership plus shipping/handling)
Payment System * (click here to download a mail-in pdf for check or money orders)	Online Processing Visa and Mastercard Only
Your Name * Your First & Last name
Your E-Mail Address * A confirmation email will be sent to you at this address
Choose a Login Name (User ID) * It must be 5 or more characters in length and may only contain small letters, numbers, and the underscore '_'
Choose a Password * Must be 5 or more characters, not contain the login name and may only contain small letters, numbers and the userscore '_'
Confirm your password * Enter password again
Enter Verification Text * Please type text from image
T-Shirt Size * SORRY... a t-shirt is NOT included in your welcome package. This is just for future reference.
Phone Number * Enter your Home or Mobile Phone number: U.S. Format (312) 555-1212 Area code + full local number International Format (044) 07700 954 321 Country code +full local number
Date of Birth * Please enter your date of birth in MM-DD-YYYY format
Street* Please enter your shipping address street
City* Please enter your shipping address city
Country* Please enter your shipping country
State* Please enter your shipping address state. (Select "Outside U.S. and Canada" for international orders)
Shipping Province Shipping Province for International members
ZIP* Please enter your shipping address zip code (for U.S. orders) or postal code for international
COUPONS
Enter coupon code if you get any coupon code from advertising, please enter it here