Customer Registration Form
(Free Membership Form)

  1. If you want to skip Customer Registration Form, please go directly to "the Order Form"
  2. Even if you don't buy now, you can still join our membership for free and get informed on the up to date card information and special discount information.
  3. This information will not be revealed  to other people without your written consent.  We need this information only for validating your identity since we have our cards available to you before you pay.  (We strictly observe privacy policy).   Required entries are shown with *
* Registration (Join Callcarefree Membership for free) If you do not place an order this time, make an appropriate selection.
* First Name (your official name registered in your institution)
* Last Name
* Affiliation (name of colleges, universities, or companies)
Major (or department in your company)
* Classification
* Expected Date of Affiliation Termination with your Institution (mmm/yyyy) i.e., May 2000
* Phone Number (Home) (i.e., 212-433-8969)
Phone Number (Work) (i.e., 405-565-8357)
* Email Address (Please use the email address issued by your institution)  
Home Page URL: (if you have)
* Street Address
* City   * State   * Zip
* Who referred our products to you?
(How did you know about us?)

 
Your average monthly telephone bill amount (i.e., $100)
 * Which countries do you call often?
 (i.e., Korea, USA, Japan, Taiwan), Write in the order from the most often to the least often.
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