Wufoo

Membership Application

Membership aboard the USS Blackheart is completely free. All we need is some information from you, and you'll be ready to sail the Final Frontier with the Pirates of the Starfleet! You can also contact us by phone by calling 888-ADM-KIRK (236-5475) toll-free in the United States.

Name * First Last
E-mail Address *
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Birthdate * MM / DD / YYYY
Telephone ### - ### - ####
T-shirt Size
You're also interested in the following groups aboard Blackheart...
728th Marine Strike Group (Marines) VF-703: The Flying Dutchmen (Fighter Pilots) Trader's Guild (Independent Merchants)
The Blackheart Crew E-mail List, 'Privateers'
Yes, please add me to the list! No! I would prefer to receive nothing!
The Blackheart Broadside
Yes, I'd love a weekly ad-free newsletter filled with dorky things related to my interests! No. If I get any more E-mail, I will set the entire internet on fire.
A Cool 'Access All Areas' Blackheart Membership Card
Yes, please mail me one for free! No. If I get another membership card, I will set the entire internet on fire.
Do Not Fill This Out