Speech Gems Sign-up Page
Using the Fax Option for Billing

In order to get started on your journey to better speech making, please print out the following sign-up form, complete your information and fax it to (306) 652-2580.

You will be billed for $17 for your one year subscription.
Your credit card will show a debit to Active Connections Network, our parent company.

Once we receive your fax, we will process your application, assign you a user name and password and send this information to you via email or fax, along with a receipt. Thanks for joining us at speechgems.

Full Name:
Address:
City:
State/Province:
Country:
Zip/Postal Code:
Phone: ( )
Fax: ( )
Email:
Choose Credit Card

 VISA
Master Card
Name on Card:
Card Number:
Expiry Date:
Please send my user name and password, along with my receipt via

 e-mail
fax
Signature:



We value you as a customer and as a fellow speech maker. If you have concerns about the security of your information, please read our privacy policy.

Suggestions for additions to the private site are also always welcome at SpGfeedback@rebin.com

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is presented by
Active Connections Network Inc