Step 1:  Select Membership: (Annual Membership Costs Below)
United States $31.50 + $5.00 postage/handling = $36.50 US Funds
Canada $31.50 + $6.00 postage/handling = $37.50 US Funds
International $31.50 + $8.00 postage/handling = $39.50 US Funds
 

Step 2:  Member Information: (* Indicates Required Information)
First Name*:
Last Name*:
Street Address*:
Suite or Apartment:
City*:
State/Province*:
Country*:
Zip/Postal Code*:
Phone Number:
Fax Number:
Email Address*:
Would you like to be added to the
Mike Modano Fan Club e-newsletter list?
Gender:
Birthday of Member:
T-Shirt Size:
   

Step 3:  Credit Card Billing Information: (* Indicates Required Information)
Check this box to use same information as above:
 
First Name*:
Last Name*:
Billing Address*:
Suite or Apartment:
City*:
State/Province*:
Country*:
Zip/Postal Code*:
Credit Card Type*:
Credit Card Number*:
Credit Card Expiration*:
Additional email address for sending order confirmation (optional):