The Robert Cuccioli 2013 Fan Club Membership Application
State:________________ Zip:____________ Country:______________
Birthdate (year not needed)_______________________
Single membership $20
Family membership -- $20 first member plus $10 for all additional members living in same house. ($30 maximum)
International membership $30
New member packages will be mailed within 5-7 business days after receipt of payment.
Please email Gay@RobertCuccioli.com if any questions
All information provided is kept private and confidential.
Email and phone numbers will be used for urgent news and quick communication.
Please make all checks payable to GAY DUPRE and mailed to:
The Robert Cuccioli Fan Club
% Gay Dupre
830 Rockbass Road
Suwanee, Georgia 30024