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<br />, <br /> <br />Date: <br /> <br />\\M \ \() <br />\ \ <br /> <br />WITNESSES: <br /> <br />Printed Name <br /> <br />Street Address <br /> <br />City, State. Zip Code <br /> <br />Printed Name <br /> <br />Street Address <br /> <br />City, State Zip Code <br /> <br />-, <br /> <br />~~ ~\~ Y~m~~ <br /> <br />G D CLUB, INC., <br /> <br />~:\b~ <br /> <br />Signature <br /> <br />Signature <br /> <br />Page 8 of9 <br /> <br />"hf. .q!f;- <br />