Date

To the Mail Preference Service:

Please register my name and address with the Mail Preference Service.

Name: _________________________________

Address, Apt. #: _______________________________________

City, State, Zip: ________________________________________

Regards,

_______________
(Signature)

Enclosed: My __check or __ money order for $1.

Mail To:
Mail Preference Service
Direct Marketing Association
P. O. Box 643
Carmel, NY 10512