ALPHA CIGAR OF THE MONTH CLUB MEMBERSHIP FORM
Please Print out this form and send it by mail or by fax

Yes, I wish to join the ALPHA CIGAR OF THE MONTH. I will receive 3 different Cuban cigars a month. PLEASE PRINT
Name:
Address:
City:	Province/ State:	Postal / Zip Code:
Day Phone: ( )	Fax: ( )
Visa / MasterCard No.	Expiry: __ / ____
I am over 19 years of age...............................................Signature:
Shipment Address:
Length of Membership: 3 Months $400.00 CAD 6 Months $700.00 CAD 12 Months $1200.00 CAD
Please indicate how you discovered the Alpha Club:

Fax to: (604) 944-1302

or

Mail to:
ALPHA TOBACCO, House of Cigars
829 Denman St.
Vancouver, B.C.
Canada V6G 2L7

Be sure to tell all of your friends so they can enjoy the same rewards you do!