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  1.                                                                                 
  2. ................................................................................
  3. .                            Mailing List System                               .
  4. ................................................................................
  5. . Name      _____________ _ ______________                                     .
  6. . Company   ______________________________                                     .
  7. . Address   ______________________________                                     .
  8. .           ______________________________                                     .
  9. .           _____________________ __ _____                                     .
  10. . Phone     ______________                                                     .
  11. . Comments  ______________________________                                     .
  12. ................................................................................
  13. .                             Selection Switches                               .
  14. ................................................................................
  15. .   Switch 1   .    Switch 2   .    Switch 3   .    Switch 4   .    Switch 5   .
  16. .      _       .       _       .       _       .       _       .       _       .
  17. ................................................................................
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