TLC MEMBER APPLICATION
Step 1
Step 2
Step 3
Step 4
Step 5
DONE!
Choices for service in order of preference are:
(1)
(2)
(3)
Your Name (First, M, Last):
Legal name (if differnet):
Gender:
Male
Female
Date of Birth:
Email Address:
Home Address:
City:
State:
---
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
Mailing address (if different) :
City:
State:
---
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
Phone # :
Cell Phone # :
Citizenship:
Do you have a passport?
Yes
No
When does it expire?
(If you already have a passport)
Are you dating?
Yes
No
Is your date going on TLC?
Yes
No
What is the name of your date?
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