NAME A STAR LIVE REGISTRATION FORM Please print or type the information required in this form accurately and check spelling. Certain details will appear on official certificates and other printed material. Please note that fields marked with an asterisk (*) MUST be completed. STAR NAME REGISTRATION DETAILS New Star Name *(maximum 25 characters, including spaces): Second Star Name (necessary only if a binary star system is named): Select Constellation: General Constellations: In Honor Of * (whom the star is to be named after): Registration Date (mm/dd/yyyy): * ___Andromeda ___Cassiopeia ___Orion ___Ursa Major Message For Recipient (this message will be printed on the Star Certificate) To: ___Ursa Minor ___No preference Zodiac Constellations: Message (maximum 200 characters, including spaces): ___Aries ___Aquarius ___Cancer ___Capricorn ___Gemini ___Leo ___Libra ___Pisces ___Sagittarius ___Scorpio ___Taurus From: ___Virgo GIFT SET SELECTION *- To view the content of each gift set please visit www.NameAStarLive.com Note: Instant Gift Sets, Digital Astrophoto, Digital Star Chart and Digital Star Certificates are delivered free of charge via email. Shipping charges are applicable ONLY if additional items are ordered that require shipping via carrier (USPS). Please see shipping chart for pricing information. Generic Gift Set Instant Gift Set(1) Star Bear Gift Set Deluxe Gift Set Framed Gift Set Ultimate Gift Set Name A Single Star Name A Binary Star System $19.95 $34.90 $39.95 $54.90 $59.95 $74.90 $79.95 $94.90 $99.00 $114.90 Additional Options (See shipping chart for prices) Digital (received via email) Printed (in display folder) Framed (printed and framed) Astrophoto Star Chart Star Certificate $19.95 $9.95 $9.95 $29.95 $14.95 $9.95 $49.95 $34.95 $29.95 Star Bear $19.95 Qty. Totals Price Shipping: (please see prices below) Sub total: Tax: Total: DELIVERY ADDRESS First Name: * Last Name: * Address:* City: * Phone Number (with area code): * PAYMENT INFORMATION State: * Email Address: * Country: * Zip Code/Postal Code: * We accept most major credit cards, personal checks, money orders, cashier's checks denominated in U.S. dollars. We also accept international money orders (outside USA) and Smart Cards that have a Visa logo. If paying by credit card please ensure that you enter the correct credit card number and expiration date, as mistakes will delay delivery of the gift. Please make your check or money order payable to Space Services Inc., LLC. Do not endorse the check or the money order. Credit Card: Visa ¨ Credit Card Number: Discover ¨ Amex ¨ Master Card ¨ Check ¨ Money Order ¨ Expiration Date (mm/yyyy): Signature: BILLING ADDRESS SAME AS DELIVERY ADDRESS First Name: * Last Name:* Address: * City: * State/Province: * Phone Number (with area code): * Country: * Zip Code/Postal Code: * Email Address: * Comments: ORDER INSTRUCTIONS Please print or type the information required in this form accurately and check spelling. Certain details will appear on official certificates and other printed material. Please note that fields marked with an asterisk (*) MUST be completed. Only after we receive this form together with the payment information will we be able to produce and deliver all documents showing the star’s name and coordinates. Mail or fax this form to: Name A Star Live., 2536 Amherst St Suite J, Houston Texas 77005, U.S.A. Phone +1.713.524.2568; 1.866.776.2538; Fax: +1.713.527.7149 Star Name Registration Details: New Star Name - Please enter the name you wish to give your star. Registration Date - If you have a special date you would like to celebrate (i.e. anniversaries, graduations, etc), enter it here. In Honor Of - print the name of the person in whose honor the star is to be named. Constellation - You have the option to indicate which constellation (stellar region) in which you would like to have the star named. Mark “No Preference” if you do not wish to pick a constellation. Message for the Recipient: Please limit your message to 200 characters, including spaces. For example, the sentence, “I have named a star for you” represents 27 characters. Delivery Address: If this is the same address as the person placing the order, simply check the box as shown. A complete mailing address MUST be included. Make sure to include an email address especially if you order a Star Certificate. Billing Information: Please enter the details of the person ordering and paying for the gift set. Please provide telephone numbers where we can easily contact you. This is required should there be a problem with your order. You must enter a valid email address, as this is where your order confirmation will be sent. Domestic Priority Mail 2-3 business days Instant Gift Sets(2) (1lb) FREE Domestic Express Mail overnight in most areas FREE Generic Product Shipping Prices (1) Star Bear Gift Sets (1lb) FREE Deluxe Gift Sets (1lb) FREE Framed Gift Sets (4lb) FREE Ultimate Gift Set (6lb) FREE $19.95 $19.95 $27.95 $37.95 International Global Priority Mail 6-10 business days FREE $21.95 $21.95 $33.95 $43.95 Global Express Mail 3-5 business days FREE $31.95 $31.95 $44.95 $56.95 Additional bear Add $13.00 Add $5.00 Add $13.00 Add $7.00 Add $0.00 Additional frame Add $21.00 Add $14.00 Add $16.00 Add $10.00 Add $7.00 (1) Our packages are delivered via USPS and include a tracking number. (2) Instant Gift Sets, Digital Astrophoto, Digital Star Chart and Digital Star Certificates are delivered free of charge via email. Shipping charges are weight based and applicable ONLY if additional items are ordered that require shipping via carrier (USPS).