Use this form to complete the application for insurance.  This is only for those who have been included in the pre-paid  insurance deal, feb-march 2003.

Sienkiewicz Society

 

Application form: you MUST sign and mail this for your coverage to start!  

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(2 formats, same form! sometime one or the other is easier to print if you have any problems printing this form e-mail me with a mailing address or fax number, and I'll send it to you orlirva@yahoo.com)

Mail signed form to:  

             OWLHF, 1130 Sheridan Ave

               Ste 160,

             Cody WY, 82414

Further essential information you must read:

 

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   <.TIF                  .jpg>              owsafety.jpg (305589 bytes)

or, see http://www.oldwest.org