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<title>William Jennings Bryan Recognition Project</title>
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<b><i>
<p ALIGN="CENTER"><font face="Arial" size="3">William Jennings Bryan Recognition
Project</font></p>
</i></b>
<p ALIGN="CENTER"><font SIZE="3" face="Arial"><b>Enrollment Form</b></font></p>
<i>
<p ALIGN="CENTER"><font SIZE="2" face="Arial">(There is no financial obligation
associated with your participation.)</font></p>
</i><b><i>
<p ALIGN="CENTER"><font SIZE="3" face="Arial">
<img border="0" src="images/checkbox-small.gif" width="18" height="17">
Please list me/my
organization as a supporter<br>
of the William Jennings Bryan Recognition Project<br>
to memorialize his contributions and to strengthen<br>
the values that Bryan espoused in his public<br>
service to the Nation and the world.</font></p>
</i><font FACE="Arial"><i>
<div align="center">
<table border="0" cellspacing="1" width="424" height="515">
<tr>
<td width="104" height="20"><font face="Arial" size="3"><b><i>Organization</i></b>:</font></td>
<td width="306" height="20"><font face="Arial" size="3">____________________________________________________________</font></td>
</tr>
<tr>
<td width="104" height="21">
<img border="0" src="images/space.gif" width="15" height="14"></td>
<td width="306" height="21"></td>
</tr>
<tr>
<td width="104" height="20"><font face="Arial" size="3"><b><i>Your Name</i></b>:</font></td>
<td width="306" height="20"><font face="Arial" size="3">____________________________________________________________</font></td>
</tr>
<tr>
<td width="104" height="21">
<img border="0" src="images/space.gif" width="15" height="14"></td>
<td width="306" height="21"></td>
</tr>
<tr>
<td width="104" height="20"><font face="Arial" size="3"><b><i>Title</i></b>:</font></td>
<td width="306" height="20"><font face="Arial" size="3">____________________________________________________________</font></td>
</tr>
<tr>
<td width="104" height="21">
<img border="0" src="images/space.gif" width="15" height="14"></td>
<td width="306" height="21"></td>
</tr>
<tr>
<td width="104" height="21">
<img border="0" src="images/space.gif" width="15" height="14"></td>
<td width="306" height="21"></td>
</tr>
<tr>
<td width="104" height="20"><font face="Arial" size="3"><i><b>Address</b></i>:</font></td>
<td width="306" height="20"><font face="Arial" size="3">____________________________________________________________</font></td>
</tr>
<tr>
<td width="104" height="21">
<img border="0" src="images/space.gif" width="15" height="14"></td>
<td width="306" height="21"></td>
</tr>
<tr>
<td width="104" height="20"><font face="Arial" size="3"><b><i>City/State/ZIP</i></b>:</font></td>
<td width="306" height="20"><font face="Arial" size="3">____________________________________________________________</font></td>
</tr>
<tr>
<td width="104" height="21">
<img border="0" src="images/space.gif" width="15" height="14"></td>
<td width="306" height="21"></td>
</tr>
<tr>
<td width="104" height="21"></td>
<td width="306" height="21"><font face="Arial" size="3">____________________________________________________________</font></td>
</tr>
<tr>
<td width="104" height="21">
<img border="0" src="images/space.gif" width="15" height="14"></td>
<td width="306" height="21">
</td>
</tr>
<tr>
<td width="104" height="20"><font face="Arial" size="3"><b><i>Telephone</i></b>:</font></td>
<td width="306" height="20">
<p align="left"><font face="Arial" size="3">____________________________________________________________</font></td>
</tr>
<tr>
<td width="104" height="21">
<img border="0" src="images/space.gif" width="15" height="14"></td>
<td width="306" height="21"></td>
</tr>
<tr>
<td width="104" height="20"><font face="Arial" size="3"><i><b>Fax</b></i>:</font></td>
<td width="306" height="20"><font face="Arial" size="3">____________________________________________________________</font></td>
</tr>
<tr>
<td width="104" height="21">
<img border="0" src="images/space.gif" width="15" height="14"></td>
<td width="306" height="21"></td>
</tr>
<tr>
<td width="104" height="20"><font face="Arial" size="3"><b><i>E-mail</i></b>:</font></td>
<td width="306" height="20"><font face="Arial" size="3">____________________________________________________________</font></td>
</tr>
<tr>
<td width="104" height="21">
<img border="0" src="images/space.gif" width="15" height="14"></td>
<td width="306" height="21"></td>
</tr>
<tr>
<td width="104" height="20"><font face="Arial" size="3"><b><i>Signature</i></b>:</font></td>
<td width="306" height="20"><font face="Arial" size="3">____________________________________________________________</font></td>
</tr>
</table>
</div>
</i></font></b>
<p ALIGN="CENTER"><font SIZE="3" face="Arial">You will receive invitations to
memorial events,<br>
planning meetings and related activities.</font></p>
<font FACE="Arial">
<b><i>
</i></b><i>
<p> </p>
<p>Please mail your completed form to:</p>
</i>
<p ALIGN="CENTER"><b>The Agribusiness Council - WJBRP</b><br>
P.O. Box 5565<br>
Washington, DC 20016</p>
<i></i></font>
<b><i>
<p ALIGN="CENTER"><font SIZE="2" face="Arial">"Statesman, yet friend to
truth, of soul sincere,<br>
in action faithful, and in honor clear"</font></p>
</i></b><p ALIGN="CENTER"><b><a href="bryan.htm"><font face="Arial" size="1">Bryan
Recognition Project</font></a></b></p>
<p ALIGN="CENTER"><b><a href="bryan_contribution.htm"><font face="Arial" size="1">Contribution
Form</font></a></b></p>
<p ALIGN="CENTER"><a href="http://www.Agribusinesscouncil.org/default.htm"><b><font FACE="Times New Roman" size="1">
Home
</font>
</b></a></p>
<font FACE="Times New Roman" SIZE="2">
<p ALIGN="CENTER"> </p>
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