Print/complete this form and mail to...

     FSSNOC, INC.
     P.O. Box 1809
     Hutchinson, Kansas 67504-1809

     Please make checks and money orders ( in U.S. funds )
     payable to: FSSNOC, INC.

 
                  "OKAY... Sign me up!"


     Name __________________________________________  Age  ______

     Address ____________________________________________________

     City ____________________ St. _____ Zip ____________________

     Phone (_____)___________________    Shirt Size _____________
                                                       50/50
     Cycle Description __________________________________________

     1 Year USA Membership - $34
     1 Year International Membership - $42

     Disclaimer:

     I understand that the FSSNOC cannot assume responsibility
     for any aspect of my safety and that if I participate in any
     member gathering, I do so voluntarily on my own assessment of
     all facilities and conditions, assuming all risk; and I release 
     and hold the FSSNOC and FSSNOC director Jack Robinson harmless
     for any injury or loss to my person or property which may
     result therefrom.

     Signature Required: X________________________________________