Image-in-Asian Magazine Address Database

Image-in-Asian Magazine
Mailing List

If you live in the Virginia/District of Columbia/Maryland area and would like to receive Image-in-Asian Magazine in snail-mail, please fill out your address and click SEND ADDRESS button. Please click ONLY ONCE, 'cause if you click twice we will get two mail with the same address and the guy who updates the database will throw both into a folder named "Those irritating people who have the habit of clicking twice". Then it may never see the light in a post office.

Leave blank the ones that do not apply to you, do not type NONE or NIL, it could have dire consequences. For instance if you typed NONE against NAMES OF CHILDREN, your future children will be known as NONE!

You need not fill in everything, but if you do not fill in the required fields, (marked with *) the form processing robot is gonna nag you.

We do not sell or give out our address list... never.

.

FIRST NAME:
(First Wife's, then '&', then Husband's)

LAST NAME:*

NAMES OF CHILDREN:
(If none, leave blank)

STREET ADDRESS & APT #:*

CITY:*

STATE:*
ZIP:*

HOME TELEPHONE:

HOME FAX:

OFFICE TELEPHONE:

OFFICE FAX:

PAGER/MOBILE #:

E-MAIL ADDRESS:*

ADD TO OUR E-MAIL LIST?:*
(very rarely would we email you )

Yes
No

PREVIOUS SPOUSE'S NAME:

HOW DID YOU HEAR ABOUT US? *
Image-in-Asian Television
Image-in-Asian Magazine
South Asian Magazine
Ramayan TV advertisement
Hyperlink from another site
Web search
Our print ad in a souvenir or such
Somebody told you
Other

ANY COMMENTS?:
(... about anything! We love reading stuff that people have to say)

Copyright © MCMXCVIII Image-in-Asian. All rights reserved.

FIRST NAME: (First Wife's, then '&', then Husband's)
LAST NAME:*
NAMES OF CHILDREN: (If none, leave blank)
STREET ADDRESS & APT #:*
CITY:*
STATE:*	ZIP:*
HOME TELEPHONE:
HOME FAX:
OFFICE TELEPHONE:
OFFICE FAX:
PAGER/MOBILE #:
E-MAIL ADDRESS:*
ADD TO OUR E-MAIL LIST?:* (very rarely would we email you )	Yes No
PREVIOUS SPOUSE'S NAME:
HOW DID YOU HEAR ABOUT US? *	Image-in-Asian Television Image-in-Asian Magazine South Asian Magazine Ramayan TV advertisement Hyperlink from another site Web search Our print ad in a souvenir or such Somebody told you Other
ANY COMMENTS?: (... about anything! We love reading stuff that people have to say)