Member ID card Member ID Card and Contact info. YOUR MEMBERSHIP ID CARD1. YOUR ID CARD INFONAME - Exactly as you want it on your ID CardCITY - The location where you represent inDIEHARD SINCE - The year you became a 49er fanYOUR ID CARD PICTUREID 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.jpgIMAGE NAME - Exactly as you named it EXAMPLE: john_doe49.jpgUPLOAD 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 AddressYOUR MEMBERSHIP ID CARD WILL BE MAILED HEREName 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 AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinian TerritoryPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaWestern SamoaYemenZambiaZimbabweCountry Direct ContactBEST WAY TO REACH YOU ABOUT WINNINGS OR GIVEAWAYSPhone Email Shirt SizeType MaleFemaleSize XSSMLXLXXLXXXL Social MediaTO BE INCLUDED IN ADDITIONAL DRAWINGS VIA SOCIAL MEDIAFacebook Twitter Instagram Before SubmittingPlease 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 VerificationPlease enter any two digits *Example: 12This box is for spam protection - <strong>please leave it blank</strong>: