______________________________________________________________________________
                               |
MAIL THIS COMPLETED FORM TO:   | Member's Information:
                               |
Sysop                          | Name: _______________________________________
c/o THE BBS                    |
Post Office Box 0000           | City:________________________________________
Yourtown, NJ 08075             |
                               | State __________  Zip Code __________________
                               |
                               | Phone: ______________________________________
                               |
                               |

1 Membership Kits w/ 20 2 for 1 Coupons        14.95

2 Membership Kits each w/ 20 2 for 1 Coupons   25.00


Your membership package from the Federal Music & Video Club will be
mailed to you via first class mail from our distributor.  You should
receive your coupons within two weeks.

          Please make all checks payable to:  Sysop's Name

Please remit by personal or company check, money orders take longer to
clear our bank. The proceeds from club memberships go directly to up-grading
and maintaining this BBS.
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