Please use BLOCK CAPITALS

Mr/Mrs/Ms/Miss/Title . . . . . . . . . . . .
Surname . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
First Name(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . . . . . .
. . .  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Town . . . . . . . . . . . . . . . . .   County . . . . . . . . . . . . . .
Post Code . . . . . . . . . . . . . .
E-mail Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Personal details are kept by MAK Books in accordance with the Data Protection Act 1998, and no details are passed to third parties.

I, the applicant, hereby apply to renew my agreement as (Tick):

� District Promoter -- Postal Districts (e.g. OX14 & OX15):
               . . . . . . . .   and   . . . . . . . .
� Area Manager -- Postal Area (e.g. OX): . . . . . . . .

Date first registered: . . . . . /. . . . . /. . . . . .   (dd/mm/yy)

I confirm that:
(a) I have read and understood the Terms and Conditions, and I agree to abide
     by the same;
(b) I am over 18 years of age;
(c) If my application is accepted, my Promotership/ Managership will not in any
     way conflict with or constitute a breach of any agreement or arrangement
     which I may have with a third party; and
(d) The information given by me in this application is true.

I enclose the payment for the registration fee (in UK Sterling and payable to MAK Books) by (Tick):
  � Cheque
  � Postal Order

Signature of Applicant . . . . . . . . . . . . . . . . . .  Date . . . . . . . . .