THIS SUBSCRIPTION APPLICATION MUST BE USED BY LUTCFs IN ORDER TO RECEIVE THEIR DISCOUNT. LUTCFs MUST INCLUDE A COPY OF THEIR BUSINESS CARD SHOWING THE LUTCF DESIGNATION OR OTHER WRITTEN DOCUMENTATION THAT THEY HOLD THE LUTCF DESIGNATION.

PLEASE PRINT A COPY OF THIS PAGE. ALL OF THE INFORMATION MUST BE COMPLETED FOR YOUR VSA SUBSCRIPTION APPLICATION TO BE PROCESSED. PLEASE FAX YOUR COMPLETED APPLICATION TO 1-512-457-0377. REMEMBER, THE FIRST MONTH IS FREE!

1.	Personal Information
	Your Name:__________________________________ E-Mail Address (Required):______________________ Company Affiliation:___________________________
	Telephone No. (Required): (_____)____________
	Fax No.: (_____)_____________

2.

If your company is sponsoring your subscription, complete your 3-digit company code (LUTCFs must include a copy of their business card with this application in order to receive their discount): Company Code:_______ (Your company or LUTCF discounted subscription fee will be confirmed in the enrollment e-mail you are sent)

3.	Request Username and Password:You may use letters and/or numbers, but keep them simple and between 1 and 8 characters:
	Username: 1st Choice: _______________2nd Choice: _______________
	Password: 1st Choice: _______________2nd Choice: _______________

4.	Credit Card Information: __Visa __Mastercard __American Express
	Name that appears on card: ______________________________
	Credit Card Number: _____________________________________
	Signature: ___________________ Expiration Date: ____/____
	Credit Card Billing Address-- Street: ____________________
	City, State, Zip: ________________________________________