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  1.  
  2.  
  3.     Please add me as a supporter of LIST, version 7.3d:
  4.  
  5.  
  6.     Name    ______________________________________________________________
  7.  
  8.     Company ______________________________________________________________
  9.  
  10.     Address ______________________________________________________________
  11.  
  12.             ______________________________________________________________
  13.  
  14.     City    ________________________________State _______ Zip ____________
  15.  
  16.  
  17.     Amount  $____________________________________   Date   _______________
  18.                 (staple check to bottom of page)    Copies _______________
  19.  
  20.  -------------------------------[fold back here]-------------------------------
  21.                                     [tape]
  22.  
  23.                                                                  -------
  24.                                                                 | place |
  25.                                                                 | stamp |
  26.                                                                 | here  |
  27.                                                                  -------
  28.  
  29.  
  30.  
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  34.                                 Vernon D. Buerg
  35.                                 139 White Oak Circle
  36.                                 Petaluma, CA
  37.                                                 94952
  38.  
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  41.  
  42.  ---------------------------------[fold down here]-----------------------------
  43.