Wallaby Friends Individual Membership
On-line Registration Form
* Required Field
Full Name:
(Note: Please fill in name as it appears on your D.L. or other Govt. Carried ID.)
Mailing Address:
(Note: This is were you want card to be shipped to. Billing address will be asked in final payment section)
State / Providence:
Zip Code:
Date of Birth:
Example: D: 00/ M: 00/ Y: 00
Last 4 of your D.L. or Govt.
Carried I.D. #
Example: XXX1234
Contact E-mail:
If you received one of our promotion cards, please enter your code below.
If no promotion code, please just enter 0000's.
Promotion Code
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The products, ideas, opinions, concepts, expressions, art and overall look is the soul property of Wallaby Friends and its owner.  
Any unauthorized copying in-part or as a whole is strictly prohibited.
(Please Note: All minor children must have parent permission, before filling in this form.)