WFS PREFERRED MEMBERS SUBSCRIPTION APPLICATION Please complete the information
below. Submit to PDA Approval Centre. Name______________________________
D.O.B.___________________Age:______ SSN/SIN (Optional)
________________ Address_______________________
City_______________ State/Prov.________ Zip/P.Code______________ Home Tel.__ ________________ Work
Tel._ _________________ Fax Tel.__________________ Other
Tel. (specify) __________________ Email Address: _________________
Website: ____________________________ |