Magic Mushroom

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DXN Membership Application

Membership SAVES you up to 25% on retail prices on all future purchases.

There are no contracts or ongoing obligations. One purchase each calendar year keeps your membership active until the end of the following calendar year. If your membership expires, you may take up another membership if you wish.

Register below, then purchase any Member's Pack with your first order, to save up to 25% off the retail prices. (There are No contractual obligations) A Basic DXN Member Kit costs $ 27.50 and it includes a Gano toothpaste (retail value $ 10.00)

We accept DXN Membership Applications from most countries.

First Name *

Last Name *

Business Name		If applicable

Date of Birth *		Day/Month/Year

Mailing Address *

State

Postcode *

Country *		Country

Phone Number *

Mobile Number

Email Address *

Skype Id		If you use Skype. Please provide Skype ID

Notes