THE LAKESIDE ASSOCIATION

A FAN CLUB FOR ACTORS MARY BETH EVANS AND STEPHEN NICHOLS
MEMBERSHIP FORM

(Just print this page and fill out the form)

Name______________________________________________________

Address____________________________________________________

____________________________________________________

Phone_______________________ E-Mail_________________________

Birth Month and Day_____________ Occupation_____________________

How long have you been a Mary Beth Evans and/or Stephen Nichols fan?

In what professional appearances have you seen either Mary Beth and/or Stephen?

What were your favorite(s) of those appearances?

In what personal appearances have you seen either Mary Beth and/or Stephen?

What were your experience(s) or impression(s) at the personal appearances?

What are your favorite scene(s) from daytime television that Mary Beth and/or Stephen have done?

To what charities do you contribute time and/or money?

What special skills do you have that you would be willing to share with Lakesiders?

Any comments or questions that you have?