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  <o:Author>Shawn Strouse</o:Author>
  <o:LastAuthor>OnLine 2000</o:LastAuthor>
  <o:LastPrinted>2003-10-03T12:29:28Z</o:LastPrinted>
  <o:Created>2003-09-29T17:38:38Z</o:Created>
  <o:LastSaved>2004-11-25T01:39:35Z</o:LastSaved>
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  <td height=3D22 class=3Dxl58 colspan=3D2 width=3D311 style=3D'height:16.5=
pt;mso-ignore:
  colspan;width:233pt'>DSC Range Officer Training Certification Form</td>
  <td class=3Dxl55 width=3D271 style=3D'width:203pt'>APPROVED BY:</td>
  <td class=3Dxl54 width=3D40 style=3D'width:30pt'>&nbsp;</td>
  <td class=3Dxl56 width=3D271 style=3D'width:203pt'>DATE:</td>
  <td class=3Dxl30 width=3D40 style=3D'width:30pt'>&nbsp;</td>
 </tr>
 <tr height=3D21 style=3D'height:15.75pt'>
  <td height=3D21 class=3Dxl43 style=3D'height:15.75pt'>RO TRAINEE NAME:</t=
d>
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  <td class=3Dxl31 style=3D'border-top:none'>&nbsp;</td>
  <td class=3Dxl43 style=3D'border-top:none;border-left:none'>CONTACT NUMBE=
R(S):</td>
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  <td height=3D22 class=3Dxl45 style=3D'height:16.5pt'>MEMBER # :</td>
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  <td class=3Dxl46>&nbsp;</td>
  <td class=3Dxl34>&nbsp;</td>
  <td class=3Dxl41 style=3D'border-left:none'>&nbsp;</td>
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  <td height=3D17 class=3Dxl38 style=3D'height:12.75pt;border-top:none'>CEA=
SE FIRE
  CADENCE</td>
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  <td class=3Dxl31 style=3D'border-top:none'>&nbsp;</td>
  <td class=3Dxl38 style=3D'border-top:none;border-left:none'>LINE HOT CADE=
NCE</td>
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  <td height=3D17 class=3Dxl49 colspan=3D3 style=3D'height:12.75pt;mso-igno=
re:colspan'>1:<span
  style=3D'mso-spacerun:yes'>&nbsp; </span>Last round shooters, 1 more round
  before cease fire. (WAIT TILL LAST ROUND IS FIRED)</td>
  <td class=3Dxl33>&nbsp;</td>
  <td class=3Dxl49 style=3D'border-left:none'>(CHECK THAT NO PERSON(s) IS D=
OWN
  RANGE)</td>
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re:colspan'>2:<span
  style=3D'mso-spacerun:yes'>&nbsp; </span>We are making the line safe.<span
  style=3D'mso-spacerun:yes'>&nbsp; </span>CEASE-FIRE&#8230;CEASE-FIRE.<span
  style=3D'mso-spacerun:yes'>&nbsp; </span>Unload all firearms and remove a=
ll
  detachable magazines.</td>
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pt solid black'>1:<span
  style=3D'mso-spacerun:yes'>&nbsp; </span>Shooters we are preparing to mak=
e the
  line hot.<span style=3D'mso-spacerun:yes'>&nbsp; </span>Put on your</td>
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  border-right:1.0pt solid black'
  x:str=3D"Open your firearm's actions &amp; put the safety on, Step back f=
rom the benches to behind the red line.  Stay behind the red ">Open
  your firearm's actions &amp; put the safety on, Step back from the benche=
s to
  behind the red line.<span style=3D'mso-spacerun:yes'>&nbsp; </span>Stay b=
ehind
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  and ear protection.<span style=3D'mso-spacerun:yes'>&nbsp; </span>(CHECK
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re:colspan;
  border-right:1.0pt solid black'>line until the firing line has been made
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arms
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lay:
  none'>BY RO's)</span></td>
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&nbsp;
  </span>You can now go down range and change targets.<span
  style=3D'mso-spacerun:yes'>&nbsp; </span>There will be no handling of fir=
earms</td>
  <td class=3Dxl49 style=3D'border-left:none'><span
  style=3D'mso-spacerun:yes'>&nbsp;</span>when you are ready.</td>
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  <td height=3D18 class=3Dxl51 colspan=3D4 style=3D'height:13.5pt;mso-ignor=
e:colspan;
  border-right:1.0pt solid black'>or approaching the benches until further
  notice.<span style=3D'mso-spacerun:yes'>&nbsp; </span>(CHECK THAT NO FIRE=
ARMS
  ARE HANDLED OR BENCHES APPROACHED)</td>
  <td class=3Dxl51 style=3D'border-left:none'>&nbsp;</td>
  <td class=3Dxl53>&nbsp;</td>
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  <td class=3Dxl46>&nbsp;</td>
  <td class=3Dxl46>&nbsp;</td>
  <td class=3Dxl34>&nbsp;</td>
  <td class=3Dxl51 style=3D'border-left:none'>&nbsp;</td>
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  <td height=3D18 class=3Dxl37 style=3D'height:13.5pt;border-top:none'>RO T=
raining
  Date 1:</td>
  <td class=3Dxl32 style=3D'border-top:none'>check</td>
  <td class=3Dxl47 style=3D'border-top:none'>RO Training Date 2:</td>
  <td class=3Dxl32 style=3D'border-top:none'>check</td>
  <td class=3Dxl37 style=3D'border-top:none;border-left:none'>RO Training D=
ate 3:</td>
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 </tr>
 <tr height=3D17 style=3D'height:12.75pt'>
  <td height=3D17 class=3Dxl35 style=3D'height:12.75pt'>All Range Building =
doors
  &amp; Rifle Range gates locked</td>
  <td class=3Dxl36 style=3D'border-left:none'>&nbsp;</td>
  <td class=3Dxl24 style=3D'border-top:none;border-left:none'>All Range Bui=
lding
  doors &amp; Rifle Range gates locked</td>
  <td class=3Dxl25 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl24 style=3D'border-top:none;border-left:none'>All Range Bui=
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  doors &amp; Rifle Range gates locked</td>
  <td class=3Dxl25 style=3D'border-top:none;border-left:none'>&nbsp;</td>
 </tr>
 <tr height=3D17 style=3D'height:12.75pt'>
  <td height=3D17 class=3Dxl26 style=3D'height:12.75pt;border-top:none'>Ran=
ge
  Building furnace &amp; turn off upon arrival/departure</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl26 style=3D'border-top:none;border-left:none'>Range Building
  furnace &amp; turn off upon arrival/departure</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl26 style=3D'border-top:none;border-left:none'>Range Building
  furnace &amp; turn off upon arrival/departure</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
 </tr>
 <tr height=3D17 style=3D'height:12.75pt'>
  <td height=3D17 class=3Dxl26 style=3D'height:12.75pt;border-top:none'>Bac=
kstop/impact
  area inspected for tunneling/sliding</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl26 style=3D'border-top:none;border-left:none'>Backstop/impa=
ct area
  inspected for tunneling/sliding</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl26 style=3D'border-top:none;border-left:none'>Backstop/impa=
ct area
  inspected for tunneling/sliding</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
 </tr>
 <tr height=3D17 style=3D'height:12.75pt'>
  <td height=3D17 class=3Dxl26 style=3D'height:12.75pt;border-top:none'>Tar=
get
  numbers readable</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl26 style=3D'border-top:none;border-left:none'>Target numbers
  readable</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl26 style=3D'border-top:none;border-left:none'>Target numbers
  readable</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
 </tr>
 <tr height=3D17 style=3D'height:12.75pt'>
  <td height=3D17 class=3Dxl26 style=3D'height:12.75pt;border-top:none'>Tar=
get
  frames/based in good condition</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl26 style=3D'border-top:none;border-left:none'>Target frames=
/based
  in good condition</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl26 style=3D'border-top:none;border-left:none'>Target frames=
/based
  in good condition</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
 </tr>
 <tr height=3D17 style=3D'height:12.75pt'>
  <td height=3D17 class=3Dxl26 style=3D'height:12.75pt;border-top:none'>New=
 targets
  attached to frames</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl26 style=3D'border-top:none;border-left:none'>New targets a=
ttached
  to frames</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl26 style=3D'border-top:none;border-left:none'>New targets a=
ttached
  to frames</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
 </tr>
 <tr height=3D17 style=3D'height:12.75pt'>
  <td height=3D17 class=3Dxl26 style=3D'height:12.75pt;border-top:none'>Rea=
dy/spectator
  line marked</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl26 style=3D'border-top:none;border-left:none'>Ready/spectat=
or line
  marked</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl26 style=3D'border-top:none;border-left:none'>Ready/spectat=
or line
  marked</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
 </tr>
 <tr height=3D17 style=3D'height:12.75pt'>
  <td height=3D17 class=3Dxl26 style=3D'height:12.75pt;border-top:none'>Fir=
ing points
  clean and numbered</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl26 style=3D'border-top:none;border-left:none'>Firing points=
 clean
  and numbered</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl26 style=3D'border-top:none;border-left:none'>Firing points=
 clean
  and numbered</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
 </tr>
 <tr height=3D17 style=3D'height:12.75pt'>
  <td height=3D17 class=3Dxl26 style=3D'height:12.75pt;border-top:none'>Sho=
oting
  benches/tables in working order</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl26 style=3D'border-top:none;border-left:none'>Shooting
  benches/tables in working order</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl26 style=3D'border-top:none;border-left:none'>Shooting
  benches/tables in working order</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
 </tr>
 <tr height=3D17 style=3D'height:12.75pt'>
  <td height=3D17 class=3Dxl26 style=3D'height:12.75pt;border-top:none'>Fir=
st-aid kit
  filled/accessible</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl26 style=3D'border-top:none;border-left:none'>First-aid kit
  filled/accessible</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl26 style=3D'border-top:none;border-left:none'>First-aid kit
  filled/accessible</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
 </tr>
 <tr height=3D17 style=3D'height:12.75pt'>
  <td height=3D17 class=3Dxl26 style=3D'height:12.75pt;border-top:none'>Fla=
shing
  lights/PA system working</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl26 style=3D'border-top:none;border-left:none'>Flashing ligh=
ts/PA
  system working</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl26 style=3D'border-top:none;border-left:none'>Flashing ligh=
ts/PA
  system working</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
 </tr>
 <tr height=3D17 style=3D'height:12.75pt'>
  <td height=3D17 class=3Dxl26 style=3D'height:12.75pt;border-top:none'>Ran=
ge Rules
  Posted w/copies available</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl26 style=3D'border-top:none;border-left:none'>Range Rules P=
osted
  w/copies available</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl26 style=3D'border-top:none;border-left:none'>Range Rules P=
osted
  w/copies available</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
 </tr>
 <tr height=3D17 style=3D'height:12.75pt'>
  <td height=3D17 class=3Dxl26 style=3D'height:12.75pt;border-top:none'>Bul=
letin
  board hung/OOD material removed</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl26 style=3D'border-top:none;border-left:none'>Bulletin board
  hung/OOD material removed</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl26 style=3D'border-top:none;border-left:none'>Bulletin board
  hung/OOD material removed</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
 </tr>
 <tr height=3D17 style=3D'height:12.75pt'>
  <td height=3D17 class=3Dxl26 style=3D'height:12.75pt;border-top:none'>Gun=
 racks in
  working order</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl26 style=3D'border-top:none;border-left:none'>Gun racks in =
working
  order</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl26 style=3D'border-top:none;border-left:none'>Gun racks in =
working
  order</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
 </tr>
 <tr height=3D17 style=3D'height:12.75pt'>
  <td height=3D17 class=3Dxl26 style=3D'height:12.75pt;border-top:none'>Tra=
sh
  receptacles empty &amp; bags replaced</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl26 style=3D'border-top:none;border-left:none'>Trash recepta=
cles
  empty &amp; bags replaced</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl26 style=3D'border-top:none;border-left:none'>Trash recepta=
cles
  empty &amp; bags replaced</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
 </tr>
 <tr height=3D17 style=3D'height:12.75pt'>
  <td height=3D17 class=3Dxl26 style=3D'height:12.75pt;border-top:none'>Bra=
ss and
  separated Dud Buckets labeled</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl26 style=3D'border-top:none;border-left:none'>Brass and sep=
arated
  Dud Buckets labeled</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl26 style=3D'border-top:none;border-left:none'>Brass and sep=
arated
  Dud Buckets labeled</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
 </tr>
 <tr height=3D17 style=3D'height:12.75pt'>
  <td height=3D17 class=3Dxl26 style=3D'height:12.75pt;border-top:none'>Ins=
pect
  Porta-John (fill paper)</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl26 style=3D'border-top:none;border-left:none'>Inspect Porta=
-John
  (fill paper)</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl26 style=3D'border-top:none;border-left:none'>Inspect Porta=
-John
  (fill paper)</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
 </tr>
 <tr height=3D17 style=3D'height:12.75pt'>
  <td height=3D17 class=3Dxl26 style=3D'height:12.75pt;border-top:none'>Ins=
pect Fire
  Extinguisher quantity and charge</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl26 style=3D'border-top:none;border-left:none'>Inspect Fire
  Extinguisher quantity and charge</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl26 style=3D'border-top:none;border-left:none'>Inspect Fire
  Extinguisher quantity and charge</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
 </tr>
 <tr height=3D17 style=3D'height:12.75pt'>
  <td height=3D17 class=3Dxl26 style=3D'height:12.75pt;border-top:none'>Che=
ck common
  toolbox &amp; tools</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl26 style=3D'border-top:none;border-left:none'>Check common =
toolbox
  &amp; tools</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl26 style=3D'border-top:none;border-left:none'>Check common =
toolbox
  &amp; tools</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
 </tr>
 <tr height=3D17 style=3D'height:12.75pt'>
  <td height=3D17 class=3Dxl26 style=3D'height:12.75pt;border-top:none'>Che=
ck soft
  drink quantity and refrigerator condition</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl26 style=3D'border-top:none;border-left:none'>Check soft dr=
ink
  quantity and refrigerator condition</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl26 style=3D'border-top:none;border-left:none'>Check soft dr=
ink
  quantity and refrigerator condition</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
 </tr>
 <tr height=3D17 style=3D'height:12.75pt'>
  <td height=3D17 class=3Dxl26 style=3D'height:12.75pt;border-top:none'>Cle=
an desk
  top and coffee pot</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl26 style=3D'border-top:none;border-left:none'>Clean desk to=
p and
  coffee pot</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl26 style=3D'border-top:none;border-left:none'>Clean desk to=
p and
  coffee pot</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
 </tr>
 <tr height=3D17 style=3D'height:12.75pt'>
  <td height=3D17 class=3Dxl26 style=3D'height:12.75pt;border-top:none'>Che=
ck
  staplers (4) and fill with staples from box (2)</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl26 style=3D'border-top:none;border-left:none'>Check stapler=
s (4)
  and fill with staples from box (2)</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl26 style=3D'border-top:none;border-left:none'>Check stapler=
s (4)
  and fill with staples from box (2)</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
 </tr>
 <tr height=3D17 style=3D'height:12.75pt'>
  <td height=3D17 class=3Dxl26 style=3D'height:12.75pt;border-top:none'>Pho=
ne charged</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl26 style=3D'border-top:none;border-left:none'>Phone charged=
</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl26 style=3D'border-top:none;border-left:none'>Phone charged=
</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
 </tr>
 <tr height=3D17 style=3D'height:12.75pt'>
  <td height=3D17 class=3Dxl26 style=3D'height:12.75pt;border-top:none'>1&q=
uot; stack
  of targets</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl26 style=3D'border-top:none;border-left:none'>1&quot; stack=
 of
  targets</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl26 style=3D'border-top:none;border-left:none'>1&quot; stack=
 of
  targets</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
 </tr>
 <tr height=3D17 style=3D'height:12.75pt'>
  <td height=3D17 class=3Dxl26 style=3D'height:12.75pt;border-top:none'>Rec=
eipts/dual
  range receipts/envelopes/pens</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl26 style=3D'border-top:none;border-left:none'>Receipts/dual=
 range
  receipts/envelopes/pens</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl26 style=3D'border-top:none;border-left:none'>Receipts/dual=
 range
  receipts/envelopes/pens</td>
  <td class=3Dxl27 style=3D'border-top:none;border-left:none'>&nbsp;</td>
 </tr>
 <tr height=3D18 style=3D'height:13.5pt'>
  <td height=3D18 class=3Dxl28 style=3D'height:13.5pt;border-top:none'>Memb=
er
  Applications and receipts available</td>
  <td class=3Dxl29 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl28 style=3D'border-top:none;border-left:none'>Member Applic=
ations
  and receipts available</td>
  <td class=3Dxl29 style=3D'border-top:none;border-left:none'>&nbsp;</td>
  <td class=3Dxl28 style=3D'border-top:none;border-left:none'>Member Applic=
ations
  and receipts available</td>
  <td class=3Dxl29 style=3D'border-top:none;border-left:none'>&nbsp;</td>
 </tr>
 <tr height=3D17 style=3D'height:12.75pt'>
  <td height=3D17 class=3Dxl38 style=3D'height:12.75pt;border-top:none'>RO =
Name:</td>
  <td class=3Dxl31 style=3D'border-top:none'>&nbsp;</td>
  <td class=3Dxl38 style=3D'border-top:none;border-left:none'>RO Name:</td>
  <td class=3Dxl31 style=3D'border-top:none'>&nbsp;</td>
  <td class=3Dxl38 style=3D'border-top:none;border-left:none'>RO Name:</td>
  <td class=3Dxl31 style=3D'border-top:none'>&nbsp;</td>
 </tr>
 <tr height=3D17 style=3D'height:12.75pt'>
  <td height=3D17 class=3Dxl39 style=3D'height:12.75pt'>RO Signature:</td>
  <td class=3Dxl33>&nbsp;</td>
  <td class=3Dxl39 style=3D'border-left:none'>RO Signature:</td>
  <td class=3Dxl33>&nbsp;</td>
  <td class=3Dxl39 style=3D'border-left:none'>RO Signature:</td>
  <td class=3Dxl33>&nbsp;</td>
 </tr>
 <tr height=3D18 style=3D'height:13.5pt'>
  <td height=3D18 class=3Dxl40 style=3D'height:13.5pt'>Member #:</td>
  <td class=3Dxl34>&nbsp;</td>
  <td class=3Dxl40 style=3D'border-left:none'>Member #:</td>
  <td class=3Dxl34>&nbsp;</td>
  <td class=3Dxl40 style=3D'border-left:none'>Member #:</td>
  <td class=3Dxl34>&nbsp;</td>
 </tr>
 <tr height=3D17 style=3D'height:12.75pt'>
  <td height=3D17 class=3Dxl38 style=3D'height:12.75pt;border-top:none'>Com=
ments</td>
  <td class=3Dxl31 style=3D'border-top:none'>&nbsp;</td>
  <td class=3Dxl38 style=3D'border-top:none;border-left:none'>Comments</td>
  <td class=3Dxl31 style=3D'border-top:none'>&nbsp;</td>
  <td class=3Dxl38 style=3D'border-top:none;border-left:none'>Comments</td>
  <td class=3Dxl31 style=3D'border-top:none'>&nbsp;</td>
 </tr>
 <tr height=3D17 style=3D'height:12.75pt'>
  <td height=3D17 class=3Dxl57 style=3D'height:12.75pt'>&nbsp;</td>
  <td class=3Dxl33>&nbsp;</td>
  <td class=3Dxl57 style=3D'border-left:none'>&nbsp;</td>
  <td class=3Dxl33>&nbsp;</td>
  <td class=3Dxl57 style=3D'border-left:none'>&nbsp;</td>
  <td class=3Dxl33>&nbsp;</td>
 </tr>
 <tr height=3D18 style=3D'height:13.5pt'>
  <td height=3D18 class=3Dxl41 style=3D'height:13.5pt'>&nbsp;</td>
  <td class=3Dxl34>&nbsp;</td>
  <td class=3Dxl41 style=3D'border-left:none'>&nbsp;</td>
  <td class=3Dxl34>&nbsp;</td>
  <td class=3Dxl41 style=3D'border-left:none'>&nbsp;</td>
  <td class=3Dxl34>&nbsp;</td>
 </tr>
 <![if supportMisalignedColumns]>
 <tr height=3D0 style=3D'display:none'>
  <td width=3D271 style=3D'width:203pt'></td>
  <td width=3D40 style=3D'width:30pt'></td>
  <td width=3D271 style=3D'width:203pt'></td>
  <td width=3D40 style=3D'width:30pt'></td>
  <td width=3D271 style=3D'width:203pt'></td>
  <td width=3D40 style=3D'width:30pt'></td>
 </tr>
 <![endif]>
</table>

</body>

</html>

