Teachnology Gold Membership Offline Mail Sign-up Form

This form should be used to mail Check, Money, Purchase Orders. Please complete the form below. The cost of 1 year (12-month) membership is $29.99 (U.S. Dollars). Please print this page, complete the form below, enclose proper payment and mail the order form to:

My email address is:

_____________________________________

Choose a password:

_____________________________________


Daytime Phone Number: ___________________

After the form is mailed to our offices, you will receive an email confirmation when your account was successfully setup.

Name: ________________________________

Company/School: ___________________________

Address: ________________________________

City: ________________________________

State/Province: ___________________________

ZIP Code: ________________________________

Country: __________________________________

____ Check - Check Number ____________________

____ Money Order - Money Order Number____________________

____ Purchase Order - Purchase Order Number _______________

Credit Card Number: ________________________________

Credit Card Expiration Date: _________________________

Credit Card Type: Circle One

American Express, Discover,

Mastercard, Visa