Moviex Member Registration Form

Moviex Member Registration Register online at Moviex.com	Actingland, Inc. 11271 Ventura Blvd. # 395 Studio City, CA 91604

Contact Information

Full Name:
Address:
City, State, Zip:
Telephone No:		Email:
A valid email address is required so we can send your username and password.

Subscription Plan

Starter Plan	Standard Plan	Advanced Plan
$25.00 (1 Year)	$50.00 (1 Year)	$75.00 (1 Year)

Subscription Options

Payment Method & Total

Visa	MasterCard	Check / Money Order

Total Enclosed $	Make checks payable to: Actingland, Inc.

Credit Card Info

Name on Card:
Credit Card No:
Expiration Date:	(mo/yr)	CVV Code: (3 digit code on the back of your credit card.)

Member Agreement

I understand I am entering into a contract whereby I grant Actingland Incorporated, its parent, subsidiary corporations, and all affiliates a perpetual, irrevocable, worldwide, royalty-free, and non-exclusive license to reproduce, adapt, modify, translate, publish, publicly display, print, and distribute by or on any physical or electronic medium, any and all information including, but not limited to, personal descriptions, contact information, and photographs, submitted now or at any subsequent updates or modifications in the future whether the information is provided by via online forms or physical delivery. I have read, understand, and agree to these terms and the full terms and conditions that are posted on the Actingland web site. Returned checks are subject to a $25 processing fee.

Sign below indicating you understand these terms and conditions. A parent or legal guardian must sign for applicants under the age of 18.

Signature:_____________________________________________________	Check if parent or legal guardian

Complete the form by typing into each of the highlighted text areas.

After you have completed the form, print it.

Sign at the bottom.

Mail your completed and signed form to the address printed at the top of the form.

Remember to include your check or money order.

Make checks payable to: Actingland, Inc.