FIRST NAME          LAST NAME

STREET

CITY         STATE             ZIP CODE

** Check all of the items that you wish to purchase.

CLASSIC LOGO T-SHIRT (one-sided black) - $15.00

GROUND ZERO LIVE AT THE BOTTOM LINE CD - $8.00

CAMOUFLAGE LOGO T-SHIRT (one-sided) - $20.00

LONG SLEEVE LOGO T-SHIRT (one-sided, black) - $25.00

Mail Payment (check or money order please) to:

    Ken Dugan

    P.O. Box 30791

    Middleburg Hts, OH 44130