Unite4gas
    "Never Pay for gas again"
Memeber regestration

Please complete the fields below and submit it with your entry fee to be entered in both drawings.

Registration Information

Please note: Once you have paid your entry fee of $20.00USD you are now enter into both of our free gas drawings for the current month. Winners will be notified via email,phone and or US mail. To be concidered for future monthy drawings you must return each month and re-enter the drawings.
Also remember when you refer your family and friends you recieve
an additional entry for each referal who joins. 

Member referred by:
Members  Email:
Your first Name:
Your last Name: 
Address Street 1: 
Address Street 2:
Zip Code: (5 digits)
State:
Daytime Phone:
Evening Phone:
Email:
 Click the Buy now to join Next click submit  to finish        







 

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