JBRoper Productions Membership Mail Order Form

To get membership in JBRoper Productions please print, sign, and mail this form with a check or money order payable (in U.S. dollars only) to. * Please do not send cash:

JBR Productions
PO Box 7404
Springfield, Il 62791

Please Check Desired Level of Membership:
_____ 30   days $  18.95
_____ 3   months $  39.95
_____ 6   months $65.95
_____ 365 days $95.95

Username ___________________
Password  ___________________

Read and sign statement:
My signature below certifies that I am an adult, 18 years of age or older, and am lawfully entitled to receive, access and/or view adult materials in the community where I live. I understand that I am requesting material of an adult nature. I believe this material to be within the community standards of the area in which I live. I agree to not duplicate materials I receive or access. I certify that I will not share this material with, or show this material to, any other persons. I certify under penalty of perjury that all of the aforementioned is true and correct to the best of my knowledge.

Signature___________________________________________________________

Print Name_________________________________________________________

E-Mail Address _____________________________________________________

You can print this form or provide the information any way you wish.
No membership will be activated until the signed statement above has been received.