Really nothing to it. I would recommend using a VPN, but apparently there is no need for a lot of precautions. Just register a US account with a foreign credit card and go. I am in my 3rd year now.
I started out using two accounts and gift cards, but lately I just pay with my foreign card. For MP3s and videos you need the card from USunlocked.com. They give you a US credit card and a valid US mailing address. But that is, of course, more expensive, and there is no need for it just to buy books.
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