<table style="width:100%;">
<colgroup>
<col style="width: 3%" />
<col style="width: 20%" />
<col style="width: 9%" />
<col style="width: 5%" />
<col style="width: 0%" />
<col style="width: 3%" />
<col style="width: 2%" />
<col style="width: 1%" />
<col style="width: 0%" />
<col style="width: 4%" />
<col style="width: 0%" />
<col style="width: 5%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 4%" />
<col style="width: 1%" />
<col style="width: 3%" />
<col style="width: 5%" />
<col style="width: 15%" />
<col style="width: 2%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="20"><p>WASHINGTON WING</p>
<p>SENIOR ACTIVITY APPLICATION</p></td>
</tr>
<tr class="even">
<td colspan="20"><strong>NAME:</strong> Last Name, First Name, Middle
Initial (print clearly)</td>
</tr>
<tr class="odd">
<td colspan="20"><strong>     </strong></td>
</tr>
<tr class="even">
<td colspan="20"><strong>MAILING ADDRESS</strong>: (Number and
Street)</td>
</tr>
<tr class="odd">
<td colspan="20">     </td>
</tr>
<tr class="even">
<td colspan="20"><strong>CITY</strong> <strong>STATE</strong>
<strong>ZIP CODE HOME PHONE</strong></td>
</tr>
<tr class="odd">
<td colspan="3">     </td>
<td colspan="7">  </td>
<td colspan="5">     </td>
<td colspan="5">     </td>
</tr>
<tr class="even">
<td colspan="20"><strong>WORK PHONE PAGER FAX</strong></td>
</tr>
<tr class="odd">
<td colspan="5">           </td>
<td colspan="11">           </td>
<td colspan="4">           </td>
</tr>
<tr class="even">
<td colspan="20"><p id="capid-e-mail-address-civilian-occupation"
class="heading">CAPID E-MAIL ADDRESS CIVILIAN OCCUPATION</p></td>
</tr>
<tr class="odd">
<td colspan="2"><strong>     </strong></td>
<td colspan="12">     </td>
<td colspan="6">     </td>
</tr>
<tr class="even">
<td colspan="20"><strong>CAP GRADE</strong> <strong>DATE JOINED
CAP</strong> <strong>GENDER</strong></td>
</tr>
<tr class="odd">
<td colspan="4"></td>
<td colspan="3">Month:</td>
<td colspan="4">   </td>
<td>Year:</td>
<td colspan="6">    </td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="20"><p id="unit-name-charter-number" class="heading">UNIT
NAME: CHARTER NUMBER</p></td>
</tr>
<tr class="odd">
<td colspan="13"><strong>     </strong></td>
<td colspan="7">     </td>
</tr>
<tr class="even">
<td colspan="20"><h2
id="scholastic-achievement-post-graduate-years-college-years-high-school-graduate">SCHOLASTIC
ACHIEVEMENT: Post Graduate <u>  </u> years College <u>  </u> years High
School Graduate</h2></td>
</tr>
<tr class="odd">
<td colspan="20"><h2
id="previous-training-activities-and-years-attened-courses-encampments-etc.">PREVIOUS
TRAINING ACTIVITIES AND YEARS ATTENED (courses-encampments,
etc.)</h2></td>
</tr>
<tr class="even">
<td>1.</td>
<td colspan="7">     </td>
<td colspan="3">5.</td>
<td colspan="8">     </td>
<td></td>
</tr>
<tr class="odd">
<td>2.</td>
<td colspan="7">     </td>
<td colspan="3">6.</td>
<td colspan="8">     </td>
<td></td>
</tr>
<tr class="even">
<td>3.</td>
<td colspan="7">     </td>
<td colspan="3">7.</td>
<td colspan="8">     </td>
<td></td>
</tr>
<tr class="odd">
<td>4.</td>
<td colspan="7">     </td>
<td colspan="3">8.</td>
<td colspan="8">     </td>
<td></td>
</tr>
<tr class="even">
<td colspan="20"></td>
</tr>
<tr class="odd">
<td colspan="20"><h1
id="date-and-how-level-i-completed-squadron-duty-assigment">DATE AND HOW
LEVEL I COMPLETED SQUADRON DUTY ASSIGMENT</h1></td>
</tr>
<tr class="even">
<td colspan="12">      </td>
<td colspan="8">     </td>
</tr>
<tr class="odd">
<td colspan="20"><strong>SENIOR PROGRAMS AWARDS:</strong> (check
One)</td>
</tr>
<tr class="even">
<td colspan="20"><h3
id="certificate-of-proficiency-level-ii-grover-loening-award-level-iii">
Certificate of Proficiency Level II Grover Loening Award Level
III</h3></td>
</tr>
<tr class="odd">
<td colspan="20"><h3
id="paul-e-garber-award-level-iv-gil-robb-wilson-award-level-v"> Paul E,
Garber Award Level IV Gil Robb Wilson Award Level V</h3></td>
</tr>
<tr class="even">
<td colspan="20"><p
id="desired-activity-check-only-one-box-per-application"
class="heading">DESIRED ACTIVITY (check only one box per
application)</p></td>
</tr>
<tr class="odd">
<td colspan="20"><p id="encampments-flight-camps-training-other"
class="heading"> <u>ENCAMPMENTS</u> <u>FLIGHT CAMPS</u> <u>TRAINING</u>
<u>OTHER</u></p></td>
</tr>
<tr class="even">
<td colspan="17"> Summer Power WTC SLS </td>
<td colspan="2">     </td>
<td></td>
</tr>
<tr class="odd">
<td colspan="17"> Winter Glider ESTA CLC </td>
<td colspan="2">     </td>
<td></td>
</tr>
<tr class="even">
<td colspan="20"></td>
</tr>
<tr class="odd">
<td colspan="20"><strong><u>STAFF APPLICATIONS (only)</u></strong></td>
</tr>
<tr class="even">
<td colspan="2">Desired Position 1.</td>
<td colspan="4">     </td>
<td colspan="3">2.</td>
<td colspan="6">     </td>
<td colspan="2">3.</td>
<td colspan="2">     </td>
<td></td>
</tr>
<tr class="odd">
<td colspan="20"></td>
</tr>
</tbody>
</table>

**WWForm 27** October 1998 **CONTINUE ON THE BACK**

SENIOR ACTIVITY APPLICATION

+---------+-------------+---+---+-----------+--------------+---+-----+---+
| ## REL  |             |   |   |           |              |   |     |   |
| EASE AG |             |   |   |           |              |   |     |   |
| REEMENT |             |   |   |           |              |   |     |   |
+---------+-------------+---+---+-----------+--------------+---+-----+---+
| KNOW    |             |   |   |           |              |   |     |   |
| ALL MEN |             |   |   |           |              |   |     |   |
| BY      |             |   |   |           |              |   |     |   |
| THESE   |             |   |   |           |              |   |     |   |
| P       |             |   |   |           |              |   |     |   |
| RESENTS |             |   |   |           |              |   |     |   |
| that I  |             |   |   |           |              |   |     |   |
| am      |             |   |   |           |              |   |     |   |
| sub     |             |   |   |           |              |   |     |   |
| mitting |             |   |   |           |              |   |     |   |
| my      |             |   |   |           |              |   |     |   |
| appl    |             |   |   |           |              |   |     |   |
| ication |             |   |   |           |              |   |     |   |
| for     |             |   |   |           |              |   |     |   |
| Civil   |             |   |   |           |              |   |     |   |
| Air     |             |   |   |           |              |   |     |   |
| Patrol, |             |   |   |           |              |   |     |   |
| Was     |             |   |   |           |              |   |     |   |
| hington |             |   |   |           |              |   |     |   |
| Wing    |             |   |   |           |              |   |     |   |
| acti    |             |   |   |           |              |   |     |   |
| vities, |             |   |   |           |              |   |     |   |
| and I   |             |   |   |           |              |   |     |   |
| hereby  |             |   |   |           |              |   |     |   |
| vo      |             |   |   |           |              |   |     |   |
| lunteer |             |   |   |           |              |   |     |   |
| e       |             |   |   |           |              |   |     |   |
| ntirely |             |   |   |           |              |   |     |   |
| upon my |             |   |   |           |              |   |     |   |
| own     |             |   |   |           |              |   |     |   |
| init    |             |   |   |           |              |   |     |   |
| iative, |             |   |   |           |              |   |     |   |
| risk    |             |   |   |           |              |   |     |   |
| and     |             |   |   |           |              |   |     |   |
| respons |             |   |   |           |              |   |     |   |
| ibility |             |   |   |           |              |   |     |   |
| for an  |             |   |   |           |              |   |     |   |
| ass     |             |   |   |           |              |   |     |   |
| ignment |             |   |   |           |              |   |     |   |
| to      |             |   |   |           |              |   |     |   |
| part    |             |   |   |           |              |   |     |   |
| icipate |             |   |   |           |              |   |     |   |
| in this |             |   |   |           |              |   |     |   |
| a       |             |   |   |           |              |   |     |   |
| ctivity |             |   |   |           |              |   |     |   |
| at the  |             |   |   |           |              |   |     |   |
| first   |             |   |   |           |              |   |     |   |
| av      |             |   |   |           |              |   |     |   |
| ailable |             |   |   |           |              |   |     |   |
| oppo    |             |   |   |           |              |   |     |   |
| rtunity |             |   |   |           |              |   |     |   |
| and     |             |   |   |           |              |   |     |   |
| with    |             |   |   |           |              |   |     |   |
| full    |             |   |   |           |              |   |     |   |
| kn      |             |   |   |           |              |   |     |   |
| owledge |             |   |   |           |              |   |     |   |
| that    |             |   |   |           |              |   |     |   |
| such    |             |   |   |           |              |   |     |   |
| a       |             |   |   |           |              |   |     |   |
| ctivity |             |   |   |           |              |   |     |   |
| may     |             |   |   |           |              |   |     |   |
| i       |             |   |   |           |              |   |     |   |
| nclude: |             |   |   |           |              |   |     |   |
|         |             |   |   |           |              |   |     |   |
| > 1\.   |             |   |   |           |              |   |     |   |
| > Tr    |             |   |   |           |              |   |     |   |
| aveling |             |   |   |           |              |   |     |   |
| > in US |             |   |   |           |              |   |     |   |
| > Mi    |             |   |   |           |              |   |     |   |
| litary, |             |   |   |           |              |   |     |   |
| > Civil |             |   |   |           |              |   |     |   |
| > Air   |             |   |   |           |              |   |     |   |
| >       |             |   |   |           |              |   |     |   |
| Patrol, |             |   |   |           |              |   |     |   |
| > comm  |             |   |   |           |              |   |     |   |
| ercial, |             |   |   |           |              |   |     |   |
| > or    |             |   |   |           |              |   |     |   |
| >       |             |   |   |           |              |   |     |   |
| private |             |   |   |           |              |   |     |   |
| > owned |             |   |   |           |              |   |     |   |
| >       |             |   |   |           |              |   |     |   |
| vehicle |             |   |   |           |              |   |     |   |
| > from  |             |   |   |           |              |   |     |   |
| >       |             |   |   |           |              |   |     |   |
| regular |             |   |   |           |              |   |     |   |
| > place |             |   |   |           |              |   |     |   |
| > of    |             |   |   |           |              |   |     |   |
| >       |             |   |   |           |              |   |     |   |
| > the   |             |   |   |           |              |   |     |   |
| > ac    |             |   |   |           |              |   |     |   |
| tivity, |             |   |   |           |              |   |     |   |
| >       |             |   |   |           |              |   |     |   |
|  travel |             |   |   |           |              |   |     |   |
| > i     |             |   |   |           |              |   |     |   |
| ncident |             |   |   |           |              |   |     |   |
| > to    |             |   |   |           |              |   |     |   |
| > the   |             |   |   |           |              |   |     |   |
| > ac    |             |   |   |           |              |   |     |   |
| tivity, |             |   |   |           |              |   |     |   |
| > and   |             |   |   |           |              |   |     |   |
| > sub   |             |   |   |           |              |   |     |   |
| sequent |             |   |   |           |              |   |     |   |
| >       |             |   |   |           |              |   |     |   |
|  return |             |   |   |           |              |   |     |   |
| > to    |             |   |   |           |              |   |     |   |
| > place |             |   |   |           |              |   |     |   |
| > of    |             |   |   |           |              |   |     |   |
| > the   |             |   |   |           |              |   |     |   |
| > ac    |             |   |   |           |              |   |     |   |
| tivity. |             |   |   |           |              |   |     |   |
| >       |             |   |   |           |              |   |     |   |
| > 2\.   |             |   |   |           |              |   |     |   |
| >       |             |   |   |           |              |   |     |   |
|  Partic |             |   |   |           |              |   |     |   |
| ipation |             |   |   |           |              |   |     |   |
| > in    |             |   |   |           |              |   |     |   |
| > aeron |             |   |   |           |              |   |     |   |
| autical |             |   |   |           |              |   |     |   |
| > act   |             |   |   |           |              |   |     |   |
| ivities |             |   |   |           |              |   |     |   |
| > as a  |             |   |   |           |              |   |     |   |
| > pa    |             |   |   |           |              |   |     |   |
| ssenger |             |   |   |           |              |   |     |   |
| > or a  |             |   |   |           |              |   |     |   |
| >       |             |   |   |           |              |   |     |   |
| student |             |   |   |           |              |   |     |   |
| >       |             |   |   |           |              |   |     |   |
| trainee |             |   |   |           |              |   |     |   |
| > in US |             |   |   |           |              |   |     |   |
| > Mi    |             |   |   |           |              |   |     |   |
| litary, |             |   |   |           |              |   |     |   |
| > Civil |             |   |   |           |              |   |     |   |
| > Air   |             |   |   |           |              |   |     |   |
| >       |             |   |   |           |              |   |     |   |
| >       |             |   |   |           |              |   |     |   |
| Patrol, |             |   |   |           |              |   |     |   |
| > comm  |             |   |   |           |              |   |     |   |
| ercial, |             |   |   |           |              |   |     |   |
| > or    |             |   |   |           |              |   |     |   |
| > pr    |             |   |   |           |              |   |     |   |
| ivately |             |   |   |           |              |   |     |   |
| > owned |             |   |   |           |              |   |     |   |
| > ai    |             |   |   |           |              |   |     |   |
| rcraft. |             |   |   |           |              |   |     |   |
| >       |             |   |   |           |              |   |     |   |
| > 3\.   |             |   |   |           |              |   |     |   |
| >       |             |   |   |           |              |   |     |   |
|  Living |             |   |   |           |              |   |     |   |
| > for a |             |   |   |           |              |   |     |   |
| >       |             |   |   |           |              |   |     |   |
|  period |             |   |   |           |              |   |     |   |
| > of    |             |   |   |           |              |   |     |   |
| > one   |             |   |   |           |              |   |     |   |
| > week  |             |   |   |           |              |   |     |   |
| > or    |             |   |   |           |              |   |     |   |
| > more  |             |   |   |           |              |   |     |   |
| > on    |             |   |   |           |              |   |     |   |
| > dim   |             |   |   |           |              |   |     |   |
| inished |             |   |   |           |              |   |     |   |
| >       |             |   |   |           |              |   |     |   |
| rations |             |   |   |           |              |   |     |   |
| > and   |             |   |   |           |              |   |     |   |
| >       |             |   |   |           |              |   |     |   |
| minimal |             |   |   |           |              |   |     |   |
| >       |             |   |   |           |              |   |     |   |
| shelter |             |   |   |           |              |   |     |   |
| > sim   |             |   |   |           |              |   |     |   |
| ulating |             |   |   |           |              |   |     |   |
| >       |             |   |   |           |              |   |     |   |
| >       |             |   |   |           |              |   |     |   |
|  actual |             |   |   |           |              |   |     |   |
| > s     |             |   |   |           |              |   |     |   |
| urvival |             |   |   |           |              |   |     |   |
| > cond  |             |   |   |           |              |   |     |   |
| itions. |             |   |   |           |              |   |     |   |
| >       |             |   |   |           |              |   |     |   |
| > 4\.   |             |   |   |           |              |   |     |   |
| > Being |             |   |   |           |              |   |     |   |
| > qu    |             |   |   |           |              |   |     |   |
| artered |             |   |   |           |              |   |     |   |
| >       |             |   |   |           |              |   |     |   |
|  and/or |             |   |   |           |              |   |     |   |
| > sub   |             |   |   |           |              |   |     |   |
| sisting |             |   |   |           |              |   |     |   |
| > away  |             |   |   |           |              |   |     |   |
| > from  |             |   |   |           |              |   |     |   |
| >       |             |   |   |           |              |   |     |   |
| regular |             |   |   |           |              |   |     |   |
| > or    |             |   |   |           |              |   |     |   |
| >       |             |   |   |           |              |   |     |   |
|  normal |             |   |   |           |              |   |     |   |
| > place |             |   |   |           |              |   |     |   |
| > of    |             |   |   |           |              |   |     |   |
| > re    |             |   |   |           |              |   |     |   |
| sidence |             |   |   |           |              |   |     |   |
| > for   |             |   |   |           |              |   |     |   |
| > an    |             |   |   |           |              |   |     |   |
| > e     |             |   |   |           |              |   |     |   |
| xtended |             |   |   |           |              |   |     |   |
| >       |             |   |   |           |              |   |     |   |
| >       |             |   |   |           |              |   |     |   |
|  period |             |   |   |           |              |   |     |   |
| > of    |             |   |   |           |              |   |     |   |
| > time. |             |   |   |           |              |   |     |   |
|         |             |   |   |           |              |   |     |   |
| In      |             |   |   |           |              |   |     |   |
| consid  |             |   |   |           |              |   |     |   |
| eration |             |   |   |           |              |   |     |   |
| of the  |             |   |   |           |              |   |     |   |
| per     |             |   |   |           |              |   |     |   |
| mission |             |   |   |           |              |   |     |   |
| e       |             |   |   |           |              |   |     |   |
| xtended |             |   |   |           |              |   |     |   |
| to me   |             |   |   |           |              |   |     |   |
| by the  |             |   |   |           |              |   |     |   |
| Civil   |             |   |   |           |              |   |     |   |
| Air     |             |   |   |           |              |   |     |   |
| Patrol  |             |   |   |           |              |   |     |   |
| /United |             |   |   |           |              |   |     |   |
| States  |             |   |   |           |              |   |     |   |
| of      |             |   |   |           |              |   |     |   |
| America |             |   |   |           |              |   |     |   |
| through |             |   |   |           |              |   |     |   |
| its     |             |   |   |           |              |   |     |   |
| o       |             |   |   |           |              |   |     |   |
| fficers |             |   |   |           |              |   |     |   |
| and     |             |   |   |           |              |   |     |   |
| agents  |             |   |   |           |              |   |     |   |
| to      |             |   |   |           |              |   |     |   |
| part    |             |   |   |           |              |   |     |   |
| icipate |             |   |   |           |              |   |     |   |
| in said |             |   |   |           |              |   |     |   |
| ac      |             |   |   |           |              |   |     |   |
| tivity, |             |   |   |           |              |   |     |   |
| I do    |             |   |   |           |              |   |     |   |
| hereby  |             |   |   |           |              |   |     |   |
| for     |             |   |   |           |              |   |     |   |
| myself, |             |   |   |           |              |   |     |   |
| my      |             |   |   |           |              |   |     |   |
| heirs,  |             |   |   |           |              |   |     |   |
| exe     |             |   |   |           |              |   |     |   |
| cutors, |             |   |   |           |              |   |     |   |
| and     |             |   |   |           |              |   |     |   |
| a       |             |   |   |           |              |   |     |   |
| dminist |             |   |   |           |              |   |     |   |
| rators, |             |   |   |           |              |   |     |   |
| release |             |   |   |           |              |   |     |   |
| and     |             |   |   |           |              |   |     |   |
| forever |             |   |   |           |              |   |     |   |
| di      |             |   |   |           |              |   |     |   |
| scharge |             |   |   |           |              |   |     |   |
| the     |             |   |   |           |              |   |     |   |
| Civil   |             |   |   |           |              |   |     |   |
| Air     |             |   |   |           |              |   |     |   |
| Patrol, |             |   |   |           |              |   |     |   |
| Inc.    |             |   |   |           |              |   |     |   |
| /United |             |   |   |           |              |   |     |   |
| States  |             |   |   |           |              |   |     |   |
| of      |             |   |   |           |              |   |     |   |
| A       |             |   |   |           |              |   |     |   |
| merica, |             |   |   |           |              |   |     |   |
| and all |             |   |   |           |              |   |     |   |
| its     |             |   |   |           |              |   |     |   |
| of      |             |   |   |           |              |   |     |   |
| ficers, |             |   |   |           |              |   |     |   |
| agents, |             |   |   |           |              |   |     |   |
| and     |             |   |   |           |              |   |     |   |
| em      |             |   |   |           |              |   |     |   |
| ployees |             |   |   |           |              |   |     |   |
| acting  |             |   |   |           |              |   |     |   |
| o       |             |   |   |           |              |   |     |   |
| fficial |             |   |   |           |              |   |     |   |
| or      |             |   |   |           |              |   |     |   |
| oth     |             |   |   |           |              |   |     |   |
| erwise, |             |   |   |           |              |   |     |   |
| from    |             |   |   |           |              |   |     |   |
| any and |             |   |   |           |              |   |     |   |
| all     |             |   |   |           |              |   |     |   |
| claims, |             |   |   |           |              |   |     |   |
| d       |             |   |   |           |              |   |     |   |
| emands, |             |   |   |           |              |   |     |   |
| a       |             |   |   |           |              |   |     |   |
| ctions, |             |   |   |           |              |   |     |   |
| or      |             |   |   |           |              |   |     |   |
| causes  |             |   |   |           |              |   |     |   |
| of      |             |   |   |           |              |   |     |   |
| action, |             |   |   |           |              |   |     |   |
| on      |             |   |   |           |              |   |     |   |
| account |             |   |   |           |              |   |     |   |
| of my   |             |   |   |           |              |   |     |   |
| death   |             |   |   |           |              |   |     |   |
| or on   |             |   |   |           |              |   |     |   |
| account |             |   |   |           |              |   |     |   |
| of any  |             |   |   |           |              |   |     |   |
| injury  |             |   |   |           |              |   |     |   |
| to me   |             |   |   |           |              |   |     |   |
| or my   |             |   |   |           |              |   |     |   |
| p       |             |   |   |           |              |   |     |   |
| roperty |             |   |   |           |              |   |     |   |
| which   |             |   |   |           |              |   |     |   |
| may     |             |   |   |           |              |   |     |   |
| occur   |             |   |   |           |              |   |     |   |
| as a    |             |   |   |           |              |   |     |   |
| result  |             |   |   |           |              |   |     |   |
| of the  |             |   |   |           |              |   |     |   |
| neg     |             |   |   |           |              |   |     |   |
| ligence |             |   |   |           |              |   |     |   |
| of the  |             |   |   |           |              |   |     |   |
| Civil   |             |   |   |           |              |   |     |   |
| Air     |             |   |   |           |              |   |     |   |
| Patrol  |             |   |   |           |              |   |     |   |
| /United |             |   |   |           |              |   |     |   |
| States  |             |   |   |           |              |   |     |   |
| of      |             |   |   |           |              |   |     |   |
| A       |             |   |   |           |              |   |     |   |
| merica, |             |   |   |           |              |   |     |   |
| its     |             |   |   |           |              |   |     |   |
| agents  |             |   |   |           |              |   |     |   |
| or      |             |   |   |           |              |   |     |   |
| em      |             |   |   |           |              |   |     |   |
| ployees |             |   |   |           |              |   |     |   |
| during  |             |   |   |           |              |   |     |   |
| said    |             |   |   |           |              |   |     |   |
| a       |             |   |   |           |              |   |     |   |
| ctivity |             |   |   |           |              |   |     |   |
| or      |             |   |   |           |              |   |     |   |
| conti   |             |   |   |           |              |   |     |   |
| nuances |             |   |   |           |              |   |     |   |
| t       |             |   |   |           |              |   |     |   |
| hereof, |             |   |   |           |              |   |     |   |
| as well |             |   |   |           |              |   |     |   |
| as all  |             |   |   |           |              |   |     |   |
| ground  |             |   |   |           |              |   |     |   |
| and     |             |   |   |           |              |   |     |   |
| flight  |             |   |   |           |              |   |     |   |
| ope     |             |   |   |           |              |   |     |   |
| rations |             |   |   |           |              |   |     |   |
| i       |             |   |   |           |              |   |     |   |
| ncident |             |   |   |           |              |   |     |   |
| t       |             |   |   |           |              |   |     |   |
| hereto. |             |   |   |           |              |   |     |   |
+---------+-------------+---+---+-----------+--------------+---+-----+---+
|         |             |   |   |           |              |   |     |   |
+---------+-------------+---+---+-----------+--------------+---+-----+---+
| **DATE  |             |   |   |           |              |   |     |   |
| SIG     |             |   |   |           |              |   |     |   |
| NATUE** |             |   |   |           |              |   |     |   |
+---------+-------------+---+---+-----------+--------------+---+-----+---+
| **      |             |   |   |           |              |   |     |   |
| [Refund |             |   |   |           |              |   |     |   |
| Policy] |             |   |   |           |              |   |     |   |
| {.under |             |   |   |           |              |   |     |   |
| line}** |             |   |   |           |              |   |     |   |
|         |             |   |   |           |              |   |     |   |
| 1.  All |             |   |   |           |              |   |     |   |
|         |             |   |   |           |              |   |     |   |
|   appli |             |   |   |           |              |   |     |   |
| cations |             |   |   |           |              |   |     |   |
|     for |             |   |   |           |              |   |     |   |
|     any |             |   |   |           |              |   |     |   |
|     a   |             |   |   |           |              |   |     |   |
| ctivity |             |   |   |           |              |   |     |   |
|         |             |   |   |           |              |   |     |   |
|    must |             |   |   |           |              |   |     |   |
|     be  |             |   |   |           |              |   |     |   |
|     c   |             |   |   |           |              |   |     |   |
| omplete |             |   |   |           |              |   |     |   |
|     and |             |   |   |           |              |   |     |   |
|     be  |             |   |   |           |              |   |     |   |
|         |             |   |   |           |              |   |     |   |
|    acco |             |   |   |           |              |   |     |   |
| mpanied |             |   |   |           |              |   |     |   |
|     by  |             |   |   |           |              |   |     |   |
|         |             |   |   |           |              |   |     |   |
|    full |             |   |   |           |              |   |     |   |
|         |             |   |   |           |              |   |     |   |
| payment |             |   |   |           |              |   |     |   |
|     or  |             |   |   |           |              |   |     |   |
|     the |             |   |   |           |              |   |     |   |
|         |             |   |   |           |              |   |     |   |
|    appl |             |   |   |           |              |   |     |   |
| ication |             |   |   |           |              |   |     |   |
|         |             |   |   |           |              |   |     |   |
|    will |             |   |   |           |              |   |     |   |
|     not |             |   |   |           |              |   |     |   |
|     be  |             |   |   |           |              |   |     |   |
|     pro |             |   |   |           |              |   |     |   |
| cessed. |             |   |   |           |              |   |     |   |
|         |             |   |   |           |              |   |     |   |
| ```     |             |   |   |           |              |   |     |   |
| {=html} |             |   |   |           |              |   |     |   |
| <       |             |   |   |           |              |   |     |   |
| !-- --> |             |   |   |           |              |   |     |   |
| ```     |             |   |   |           |              |   |     |   |
| 2.  All |             |   |   |           |              |   |     |   |
|         |             |   |   |           |              |   |     |   |
|   out-o |             |   |   |           |              |   |     |   |
| f-state |             |   |   |           |              |   |     |   |
|         |             |   |   |           |              |   |     |   |
| seniors |             |   |   |           |              |   |     |   |
|         |             |   |   |           |              |   |     |   |
|    must |             |   |   |           |              |   |     |   |
|         |             |   |   |           |              |   |     |   |
|    send |             |   |   |           |              |   |     |   |
|         |             |   |   |           |              |   |     |   |
|    only |             |   |   |           |              |   |     |   |
|     a   |             |   |   |           |              |   |     |   |
|     ca  |             |   |   |           |              |   |     |   |
| shier's |             |   |   |           |              |   |     |   |
|         |             |   |   |           |              |   |     |   |
|   check |             |   |   |           |              |   |     |   |
|     or  |             |   |   |           |              |   |     |   |
|         |             |   |   |           |              |   |     |   |
|   money |             |   |   |           |              |   |     |   |
|         |             |   |   |           |              |   |     |   |
|  order. |             |   |   |           |              |   |     |   |
|     No  |             |   |   |           |              |   |     |   |
|     P   |             |   |   |           |              |   |     |   |
| ersonal |             |   |   |           |              |   |     |   |
|         |             |   |   |           |              |   |     |   |
| checks. |             |   |   |           |              |   |     |   |
|         |             |   |   |           |              |   |     |   |
| 3.      |             |   |   |           |              |   |     |   |
|  Refund |             |   |   |           |              |   |     |   |
|         |             |   |   |           |              |   |     |   |
| Policy: |             |   |   |           |              |   |     |   |
|     All |             |   |   |           |              |   |     |   |
|     r   |             |   |   |           |              |   |     |   |
| equests |             |   |   |           |              |   |     |   |
|     for |             |   |   |           |              |   |     |   |
|         |             |   |   |           |              |   |     |   |
| refunds |             |   |   |           |              |   |     |   |
|         |             |   |   |           |              |   |     |   |
|    must |             |   |   |           |              |   |     |   |
|     be  |             |   |   |           |              |   |     |   |
|     in  |             |   |   |           |              |   |     |   |
|         |             |   |   |           |              |   |     |   |
| writing |             |   |   |           |              |   |     |   |
|     and |             |   |   |           |              |   |     |   |
|     pos |             |   |   |           |              |   |     |   |
| tmarked |             |   |   |           |              |   |     |   |
|     by  |             |   |   |           |              |   |     |   |
|     the |             |   |   |           |              |   |     |   |
|         |             |   |   |           |              |   |     |   |
|   dates |             |   |   |           |              |   |     |   |
|         |             |   |   |           |              |   |     |   |
|   shown |             |   |   |           |              |   |     |   |
|         |             |   |   |           |              |   |     |   |
|  below. |             |   |   |           |              |   |     |   |
|         |             |   |   |           |              |   |     |   |
| > a\.   |             |   |   |           |              |   |     |   |
| >       |             |   |   |           |              |   |     |   |
|  Cancel |             |   |   |           |              |   |     |   |
| lations |             |   |   |           |              |   |     |   |
| > 14 or |             |   |   |           |              |   |     |   |
| > more  |             |   |   |           |              |   |     |   |
| > days  |             |   |   |           |              |   |     |   |
| >       |             |   |   |           |              |   |     |   |
|  before |             |   |   |           |              |   |     |   |
| > the   |             |   |   |           |              |   |     |   |
| > sc    |             |   |   |           |              |   |     |   |
| heduled |             |   |   |           |              |   |     |   |
| > a     |             |   |   |           |              |   |     |   |
| ctivity |             |   |   |           |              |   |     |   |
| > will  |             |   |   |           |              |   |     |   |
| >       |             |   |   |           |              |   |     |   |
| receive |             |   |   |           |              |   |     |   |
| > a 90% |             |   |   |           |              |   |     |   |
| >       |             |   |   |           |              |   |     |   |
| refund. |             |   |   |           |              |   |     |   |
| >       |             |   |   |           |              |   |     |   |
| > b\.   |             |   |   |           |              |   |     |   |
| >       |             |   |   |           |              |   |     |   |
|  Cancel |             |   |   |           |              |   |     |   |
| lations |             |   |   |           |              |   |     |   |
| > 5 --  |             |   |   |           |              |   |     |   |
| > 13    |             |   |   |           |              |   |     |   |
| > days  |             |   |   |           |              |   |     |   |
| >       |             |   |   |           |              |   |     |   |
|  before |             |   |   |           |              |   |     |   |
| > the   |             |   |   |           |              |   |     |   |
| > sc    |             |   |   |           |              |   |     |   |
| heduled |             |   |   |           |              |   |     |   |
| > a     |             |   |   |           |              |   |     |   |
| ctivity |             |   |   |           |              |   |     |   |
| > will  |             |   |   |           |              |   |     |   |
| >       |             |   |   |           |              |   |     |   |
| receive |             |   |   |           |              |   |     |   |
| > a 50% |             |   |   |           |              |   |     |   |
| >       |             |   |   |           |              |   |     |   |
| refund. |             |   |   |           |              |   |     |   |
| >       |             |   |   |           |              |   |     |   |
| > c\.   |             |   |   |           |              |   |     |   |
| > Cance |             |   |   |           |              |   |     |   |
| llation |             |   |   |           |              |   |     |   |
| > 4     |             |   |   |           |              |   |     |   |
| > days  |             |   |   |           |              |   |     |   |
| > or    |             |   |   |           |              |   |     |   |
| > less  |             |   |   |           |              |   |     |   |
| >       |             |   |   |           |              |   |     |   |
|  before |             |   |   |           |              |   |     |   |
| > the   |             |   |   |           |              |   |     |   |
| > sc    |             |   |   |           |              |   |     |   |
| heduled |             |   |   |           |              |   |     |   |
| > a     |             |   |   |           |              |   |     |   |
| ctivity |             |   |   |           |              |   |     |   |
| > will  |             |   |   |           |              |   |     |   |
| >       |             |   |   |           |              |   |     |   |
| receive |             |   |   |           |              |   |     |   |
| > 0%    |             |   |   |           |              |   |     |   |
| >       |             |   |   |           |              |   |     |   |
| refund. |             |   |   |           |              |   |     |   |
+---------+-------------+---+---+-----------+--------------+---+-----+---+
| **(     |             |   |   |           |              |   |     |   |
| INITIAL |             |   |   |           |              |   |     |   |
| HERE)** |             |   |   |           |              |   |     |   |
| **I     |             |   |   |           |              |   |     |   |
| have    |             |   |   |           |              |   |     |   |
| read &  |             |   |   |           |              |   |     |   |
| und     |             |   |   |           |              |   |     |   |
| erstand |             |   |   |           |              |   |     |   |
| the     |             |   |   |           |              |   |     |   |
| refund  |             |   |   |           |              |   |     |   |
| po      |             |   |   |           |              |   |     |   |
| licy.** |             |   |   |           |              |   |     |   |
+---------+-------------+---+---+-----------+--------------+---+-----+---+
| ####    |             |   |   |           |              |   |     |   |
| PRINT A |             |   |   |           |              |   |     |   |
| PPLICAN |             |   |   |           |              |   |     |   |
| T'S NAM |             |   |   |           |              |   |     |   |
| E APPLI |             |   |   |           |              |   |     |   |
| CANT'S  |             |   |   |           |              |   |     |   |
| SIGNATU |             |   |   |           |              |   |     |   |
| RE DATE |             |   |   |           |              |   |     |   |
+---------+-------------+---+---+-----------+--------------+---+-----+---+
|         |             |   |   |           |              |   |     |   |
+---------+-------------+---+---+-----------+--------------+---+-----+---+
| ######  |             |   |   |           |              |   |     |   |
|  [UNIT] |             |   |   |           |              |   |     |   |
| {.under |             |   |   |           |              |   |     |   |
| line} C |             |   |   |           |              |   |     |   |
| OMMANDE |             |   |   |           |              |   |     |   |
| R ACTIO |             |   |   |           |              |   |     |   |
| N Recom |             |   |   |           |              |   |     |   |
| mend:   |             |   |   |           |              |   |     |   |
| Approve |             |   |   |           |              |   |     |   |
| d  Disa |             |   |   |           |              |   |     |   |
| pproved |             |   |   |           |              |   |     |   |
+---------+-------------+---+---+-----------+--------------+---+-----+---+
| ####    |             |   |   |           |              |   |     |   |
| PRINT C |             |   |   |           |              |   |     |   |
| OMMANDE |             |   |   |           |              |   |     |   |
| R'S NAM |             |   |   |           |              |   |     |   |
| E COMMA |             |   |   |           |              |   |     |   |
| NDER'S  |             |   |   |           |              |   |     |   |
| SIGNATU |             |   |   |           |              |   |     |   |
| RE DATE |             |   |   |           |              |   |     |   |
+---------+-------------+---+---+-----------+--------------+---+-----+---+
|         |             |   |   |           |              |   |     |   |
|         |             |   |   |           |              |   |     |   |
|         |             |   |   |           |              |   |     |   |
|         |             |   |   |           |              |   |     |   |
|         |             |   |   |           |              |   |     |   |
+---------+-------------+---+---+-----------+--------------+---+-----+---+
| **(R    |             |   |   |           |              |   |     |   |
| EQUIRED |             |   |   |           |              |   |     |   |
| FOR     |             |   |   |           |              |   |     |   |
| MEMBERS |             |   |   |           |              |   |     |   |
| FROM    |             |   |   |           |              |   |     |   |
| OTHER   |             |   |   |           |              |   |     |   |
| THAN WA |             |   |   |           |              |   |     |   |
| WING)** |             |   |   |           |              |   |     |   |
+---------+-------------+---+---+-----------+--------------+---+-----+---+
| ######  |             |   |   |           |              |   |     |   |
|  [WING] |             |   |   |           |              |   |     |   |
| {.under |             |   |   |           |              |   |     |   |
| line} C |             |   |   |           |              |   |     |   |
| OMMANDE |             |   |   |           |              |   |     |   |
| R ACTIO |             |   |   |           |              |   |     |   |
| N Recom |             |   |   |           |              |   |     |   |
| mend:   |             |   |   |           |              |   |     |   |
| Approve |             |   |   |           |              |   |     |   |
| d  Disa |             |   |   |           |              |   |     |   |
| pproved |             |   |   |           |              |   |     |   |
+---------+-------------+---+---+-----------+--------------+---+-----+---+
| ####    |             |   |   |           |              |   |     |   |
| PRINT C |             |   |   |           |              |   |     |   |
| OMMANDE |             |   |   |           |              |   |     |   |
| R'S NAM |             |   |   |           |              |   |     |   |
| E COMMA |             |   |   |           |              |   |     |   |
| NDER'S  |             |   |   |           |              |   |     |   |
| SIGNATU |             |   |   |           |              |   |     |   |
| RE DATE |             |   |   |           |              |   |     |   |
+---------+-------------+---+---+-----------+--------------+---+-----+---+
|         |             |   |   |           |              |   |     |   |
|         |             |   |   |           |              |   |     |   |
|         |             |   |   |           |              |   |     |   |
|         |             |   |   |           |              |   |     |   |
|         |             |   |   |           |              |   |     |   |
+---------+-------------+---+---+-----------+--------------+---+-----+---+

**WWForm 27** October 1998 **(Continued)**