APPLICATION FOR PREMIUM SEARCH MEMBERSHIP-One User License
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**ALL FIELDS ARE REQUIRED**
Applicant's Name:	_________________________________________

Applicant's Address:	_________________________________________

			_________________________________________

Applicant's City:	_________________________________________

Applicant's State/Zip:	_________________________________________

Applicant's E-Mail:	_________________________________________

Proposed Username:	_________________________________________

Proposed Password:	_________________________________________


Length of Membership:  ()1 Year	 or 	()90 Days


Amount Enclosed: $_________


Please briefly describe your intended use for this account:

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Please check all that apply (optional):
A. I wish to become a Member because -
	() to avoid advertizer screens
	() to view "reserved" databases
	() to view the databases in the Work In Progress page

B. I'd like to see more of these databases developed - 
	() State Births, Deaths, Marriage & Divorces
	() City Directories/Phone Books etc.
	() other: ________________________________________________
	
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Please allow two weeks for processing. You'll be notified by e-mail.
Mail to:

The Vitalsearch Company Worldwide, Inc.
Payment Processing
4000 Pimlico Drive
Suite 114-143
Pleasanton, CA. 94588-3485