INDIVIDUAL (DISTRIBUTOR) MEMBERSHIP APPLICATION Individual applications are required for each person (including husband and wife). Please print and fax or mail to: 119 Stanford Court Irvine, CA 92612 Fax: 949-854-7687

Name: Address: City: State: Zip: Country: Day Phone: Eve Phone: Fax: Email: Company(s) affiliated with: We hereby apply for membership in the Multi-Level Marketing International Association (MLMIA). We understand that to be accepted for active membership we agree that we (a) will operate in a professional manner with high moral standards, (b) will subscribe to and uphold the principles and ethics prescribed by the Association, and (c) will continually strive to meet all requirements and standards established by the Association. We understand that to remain a member in good standing our membership must be renewed anually. Signature: Date:   INDIVIDUAL MEMBERSHIP DUES Annual Dues for United States residents for the first year -- $65.00. Thereafter $50.00 annually. Annual Dues outside of U.S. -- $100 Method of payment: Check - payable to MLMIA in US (dollars) funds only Visa AmEx MasterCard Credit Card Number: Expiration Date: Print Name On Credit Card: Signature: OFFICE USE: EX QB MS DJ ECD 1198

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