Moviex Member Registration Form

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

Complete the form in its entirety. Type your info, then print, sign and mail to the address above. Make sure to include your check / money order or enter credit card payment information below. Make checks payable to: Actingland, Inc.

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

Home Page Featured	Gallery Page Featured	Priority Search Placement
$5.00	$3.00	$3.00

Highlight Search Results	Profile Byline Text	YourName.com URL
$3.00	$3.00	$50.00

Payment Method & Total

Visa	MasterCard	Check / Money Order

Total Enclosed $

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 permission to copy, print, publish, and/or display, by or on any physical or electronic medium, any and all information including, but not limited to, my personal description, contact information, and photographs, submitted now or at any subsequent updates or modifications in the future whether the information is provided by electronic registration 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.

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