Membership Registration

Membership Application

Please complete the following form to be a fan club member. All information entered will not be transfered with for social or financial purpose, and will be maintained and used only by Priscilla Chan Internet Fan Club(PCIFC) for contact, mailing, recording, and demographic polling matters.

First Name: (Do not hit return)

Last Name:

Gender: MaleFemale

Date of Birth: Month Day 19Year

Place of Birth:

Current Residency(City, Country):

E-mail Address:

ICQ UIN:

Homepage Address(Optional):

Spoken Language(s):

List 3 idols of yours:

Why you like Priscilla:

How did you hear about this club?

Any comments or suggestion about this website?:

-- PLEASE READ -- If for some reason, you have not received the welcome mail from PCIFC within 2 weeks. Please come back here and fill out the application form again with your CORRECT e-mail address (in most cases, people fill out the wrong email address).

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Last modified on August 9,1999
This page was created on April 4,1999

Copyright 1998-1999 Priscilla Chan Internet Fan Club. All rights reserved.