PREMIUM SELECTION FORM
                  
TO REDEEM YOUR PLEDGE
Print this form using the print feature of your browser and fill out.
                  

List your selections below, and mail back this coupon or facsimile in the enclosed envelope.
 

Note: Each MP3, cassette, or CD counts as one selection.
 

For Faster service - email your selections to me - mschmid@rcn.com
(Please include member number, name and address in email)
 

$75.00 and $125.00 pledges
Selection One:
 
Selection Two:
 

$125.00 pledges
Selection Three:
 
Selection Four:
 
Member Number:
 
Name:
 
Address:
 
Phone Number (in case of questions or problems):