SFFCONV REGISTRATION FORM

    Mail this completed form to:  Simple Simon Ware
                                  533 East Indiana Ave
                                  South Bend, IN  46613-2634 


Name             :_____________________________________________________

Street           :_____________________________________________________

City, State/Prov :_____________________________________________________

Zip/Postal Code  :______________________________ Phone: _______________

[__] SFFCONV Conversion Utility............... ($1.00)
                                                        _______________

                              TOTAL AMOUNT OF DONATION  _______________


Remittance:     [__] Check      (Must be payable to "Don Devlin")      
                [__] Money Order