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* 1. Name & Mailing Address

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* 2. Email Address

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* 3. Phone Number

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* 4. What is your age?

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* 5. Would you like to listed on the Atomic Betty Club Roster?

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* 6. Emergency Contact Information

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* 7. The level of membership I will be purchasing is:

* Club membership benefits will not be in full effect until balance paid.
Purchase occurs on the "Membership" page in the Atomicbetty.club website

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* 8. I agree to keep Atomic Betty Club Codes protected, as these are for paying members.

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* 9. Atomic Betty Waiver   
I have read and agree to the terms listed in the above link. 
This is also posted on the Atomicbetty.club website.

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* 10. I am a new member to Atomic Betty!

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