Hi Friend: Thank you for becoming a member of my fan club. Please fill in the

information below and enclose a check or money order in the amount of $ 25.00 for your annual dues.

Make all checks payable to Ernie Ashworth and send to the address listed below. Thanks Again! Ernie

Name:____________________________________________

Address:___________________________________________________________________________

City:______________________________________State:______________Zip:__________________

Email Address:_______________________Website:________________________________________

Print this form out on your printer and send it to me at:

Ernie Ashworth
P.O. Box 147
Hartsville, Tn. 37074