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Member ID Card and Contact info.
YOUR MEMBERSHIP ID CARD
1. YOUR ID CARD INFO
NAME
- Exactly as you want it on your ID Card
CITY
- The location where you represent in
DIEHARD SINCE
- The year you became a 49er fan
YOUR ID CARD PICTURE
ID PICTURE
- NAME IT BEFORE UPLOADING To avoid confusion, make sure your name is associated with the image you are using.
GOOD EXAMPLE :
john_doe.jpg
BAD EXAMPLE :
image023.jpg
IMAGE NAME
- Exactly as you named it EXAMPLE: john_doe49.jpg
UPLOAD ID PICTURE
*
RECOGNIZING YOUR CLUB/CHAPTER ON ID CARD
(OPTIONAL) Group/Club/Chapter Name
This optional for those who would like to display their specific fan club directly on their ID Card.
Mailing Address
YOUR MEMBERSHIP ID CARD WILL BE MAILED HERE
Name and Address
Please fill your name and address where you would like your membership card mailed to. This will also be the address we will use for future Niner Empire info and any winnings from upcoming giveaways or drawings that may be coming to you.
First Name
*
Last Name
*
Address
Street Address
Apt, Suite, Bldg. (optional)
City
State / Province / Region
Postal / Zip Code
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo (Brazzaville)
Congo
Costa Rica
Cote d\'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (Timor Timur)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palestinian Territory
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Western Sahara
Western Samoa
Yemen
Zambia
Zimbabwe
Country
Direct Contact
BEST WAY TO REACH YOU ABOUT WINNINGS OR GIVEAWAYS
Phone
Email
Shirt Size
Type
Male
Female
Size
XS
S
M
L
XL
XXL
XXXL
Social Media
TO BE INCLUDED IN ADDITIONAL DRAWINGS VIA SOCIAL MEDIA
Facebook
Twitter
Instagram
Before Submitting
Please scroll back up and verify everything before submitting
*
I acknowledge I have double checked all the information I entered above and verify it is correct. I request my membership card to get processed with this information. I understand once I have submitted this form my membership card will be sent to processing after which, any changes to any information on the card will be subject to additional charges by the card printing company.
I Agree
Verification
Please enter any two digits
*
Example: 12
This box is for spam protection - <strong>please leave it blank</strong>:
