 
                     -------------------------------------


        Please enclose an addressed, stamped envelope with your order.

                              REGISTRATION FORM                VIP-64                            Send $10.  US currency



       Your name _______________________________________________________

       Address   _______________________________________________________

       City, State, Zip   ______________________________________________

       Company name  ___________________________________________________

       Phone number  (____) _____________________

       Where did you obtain VIP ? ______________________________________

       Enter the name below EXACTLY as you want it registered

       Name >    _______________________________________________________
                    (case sensitive)    (24 character limit)


          Mail to:
                    AL RICHARDS
                    5201 ASH
                    SHAWNEE MISSION, KANSAS  USA.
                    66205-2114


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