Membership Application
Barryzona's Southwest Magic
A Barry Manilow Sanctioned Fan Club
Date:_____________

EMail Address:________________________BMIFC ID #________________

Name:_______________________________Occupation:____________________

Street&Apt:___________________________Birth date:______________________

                  ___________________________Phone:__________________________

City/Province:___________________________State/Country & ZIP:_________________________

Would you like to be put on our daily email string?   Yes___ No___
   This could develop many messages per day.
Would you like to be on a pen pal list?   Via Email___US Mail:___No:___
Do you have time to contribute towards: (Check all items of interest)
Charity work:___Newsletter:___Mailing:___Crafts (Specify)______Other:___
Please share your favorite Barry Manilow moment:   May we print it?________
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Have you ever been a "Can't Smile Without You" girl?__________
If so, may we print your experience?________________
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What would you like to see in the newsletter?_____________________________
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Please send check or money order in the amount of $15.00.
($20.00 outside the continental United States)
Membership date:_______________ Membership ID#:__________________
Please make payable to Barryzona's Southwest Magic.

Barryzona's Southwest Magic
Attn: Debbi Pickard
2175 Colchester Ave.
Hoffman Estates IL 60192