MEMORANDUM MUST BE FILLED OUT AND SIGNED
BY REPRESENTATIVE

Subscriber’s Name

 

Print name anda prefix Mr., Mrs., or Miss

Mail Address

 

Ship Books to

Amount Collected

I hereby certify that this contract and the information appended contains
all the conditions made between me and the subscriber
and that the signature is genuine.

 

Representative

NOTICE!

The Service may be continued
after the expiration of the period
provided for herein, at a cost of
$10.00 per year payable in advance.